Healthcare Provider Details

I. General information

NPI: 1952309502
Provider Name (Legal Business Name): STEVEN J FERGUSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 DAKOTA DUNES BLVD
DAKOTA DUNES SD
57049-5176
US

IV. Provider business mailing address

305 DAKOTA DUNES BLVD
DAKOTA DUNES SD
57049-5176
US

V. Phone/Fax

Practice location:
  • Phone: 605-232-6900
  • Fax: 605-232-7007
Mailing address:
  • Phone: 605-232-6900
  • Fax: 605-232-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number551
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: