Healthcare Provider Details

I. General information

NPI: 1174838098
Provider Name (Legal Business Name): MIDWEST EYE LABORATORIES SIOUX FALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 E 26TH ST STE 2
SIOUX FALLS SD
57110-6965
US

IV. Provider business mailing address

7582 CURRELL BLVD STE 109
WOODBURY MN
55125-8212
US

V. Phone/Fax

Practice location:
  • Phone: 605-332-7052
  • Fax: 651-412-5069
Mailing address:
  • Phone: 651-739-4111
  • Fax: 651-412-5069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY J BARRETT
Title or Position: PRESIDENT/OCULARIST
Credential: BCO
Phone: 651-739-4111