Healthcare Provider Details

I. General information

NPI: 1376522029
Provider Name (Legal Business Name): JASON M HAFNER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 HARMON ST
STURGIS SD
57785-2556
US

IV. Provider business mailing address

4901 STEAMBOAT CIR
RAPID CITY SD
57702-4878
US

V. Phone/Fax

Practice location:
  • Phone: 605-347-2666
  • Fax:
Mailing address:
  • Phone: 605-720-5174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number590
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: