Healthcare Provider Details

I. General information

NPI: 1215862057
Provider Name (Legal Business Name): SYDNEY WENDT OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 JACKSON BLVD
RAPID CITY SD
57702-3484
US

IV. Provider business mailing address

2020 JACKSON BLVD
RAPID CITY SD
57702-3484
US

V. Phone/Fax

Practice location:
  • Phone: 605-342-0777
  • Fax: 605-342-7282
Mailing address:
  • Phone: 605-342-0777
  • Fax: 605-342-7282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number842
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: