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General NPI Number Information
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NPI Number | 1003305772
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Entity Type | Organization
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Legal Business Name | SIVESIND, TIMS & CLARKE, PROF. L.L.C.
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 2210 W 69TH ST STE 160
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City | SIOUX FALLS
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State | SD
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Zip | 57108-5614
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Country | US
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Telephone | 605-331-2020
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Fax | 605-638-9649
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Provider Business Mailing Address
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Address Line | 2210 W 69TH ST STE 160
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City | SIOUX FALLS
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State | SD
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Zip | 57108-5614
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Country | US
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Telephone | 605-331-2020
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Fax | 605-638-9649
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. JOSH TIMS
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Credential | OD
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Telephone | 605-400-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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