Healthcare Provider Details

I. General information

NPI: 1629090162
Provider Name (Legal Business Name): CRAIG DOCKTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 10TH AVE
MOBRIDGE SD
57601
US

IV. Provider business mailing address

310 8TH AVE NW STE 503
ABERDEEN SD
57401-2369
US

V. Phone/Fax

Practice location:
  • Phone: 605-845-2932
  • Fax:
Mailing address:
  • Phone: 605-225-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number492
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: