Healthcare Provider Details

I. General information

NPI: 1700126448
Provider Name (Legal Business Name): 20/20 EYE CANDY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 S MINNESOTA AVE SUITE 105
SIOUX FALLS SD
57108-2865
US

IV. Provider business mailing address

4900 S MINNESOTA AVE SUITE 105
SIOUX FALLS SD
57108-2865
US

V. Phone/Fax

Practice location:
  • Phone: 605-759-2389
  • Fax:
Mailing address:
  • Phone: 605-759-2389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code156FX1101X
TaxonomyOphthalmic Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code156FX1201X
TaxonomyOptometric Assistant Technician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code156FX1202X
TaxonomyOptometric Technician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number672
License Number StateSD
# 8
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number672
License Number StateSD
# 9
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number672
License Number StateSD
# 10
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: KRISTA VALARIE SMIT
Title or Position: CO-OWNER
Credential: OPTICIAN
Phone: 605-759-2389