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General NPI Number Information
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NPI Number | 1013997147
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Entity Type | Individual
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Provider Name | AMY M DEJONG O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 120 W MAIN ST
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City | VERMILLION
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State | SD
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Zip | 57069-3036
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Country | US
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Telephone | 605-624-4291
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Fax | 604-624-6822
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Provider Business Mailing Address
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Address Line | 120 W MAIN ST
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City | VERMILLION
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State | SD
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Zip | 57069-3036
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Country | US
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Telephone | 605-624-4291
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Fax | 604-624-6822
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 578
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 02198
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License Number State | IA
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