Healthcare Provider Details

I. General information

NPI: 1831206200
Provider Name (Legal Business Name): PAULA SORENSEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAULA BECKER O.D.

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 W MAIN ST SUITE 4
RAPID CITY SD
57702-2497
US

IV. Provider business mailing address

2626 W MAIN ST SUITE 4
RAPID CITY SD
57702-2497
US

V. Phone/Fax

Practice location:
  • Phone: 605-399-3811
  • Fax: 605-399-3845
Mailing address:
  • Phone: 605-399-3811
  • Fax: 605-399-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number517
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierS41393
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerMEDICARE PROVIDER NUMBER
# 2
Identifier9200072
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: