Healthcare Provider Details

I. General information

NPI: 1538309604
Provider Name (Legal Business Name): OUTPOST OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 MILITARY RD
NORTH SIOUX CITY SD
57049-3170
US

IV. Provider business mailing address

PO BOX 1993
NORTH SIOUX CITY SD
57049-1993
US

V. Phone/Fax

Practice location:
  • Phone: 605-232-3937
  • Fax: 605-235-1350
Mailing address:
  • Phone: 605-232-3937
  • Fax: 605-235-1350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0547
License Number StateSD

VIII. Authorized Official

Name: JEFF B RABBITT
Title or Position: OFFICE MANAGER
Credential:
Phone: 605-232-3937