Healthcare Provider Details

I. General information

NPI: 1013756899
Provider Name (Legal Business Name): HAWKEYE EXACT SD 1 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SHRINER ST
VERMILLION SD
57069-1155
US

IV. Provider business mailing address

11 SHRINER ST
VERMILLION SD
57069-1155
US

V. Phone/Fax

Practice location:
  • Phone: 605-624-2020
  • Fax:
Mailing address:
  • Phone: 605-624-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS WIERTZEMA
Title or Position: COO
Credential:
Phone: 605-940-6200