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General NPI Number Information
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NPI Number | 1053592394
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Entity Type | Organization
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Legal Business Name | HAWKEYE CLINIC OF SOUTH DAKOTA
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 305 DAKOTA DUNES BLVD
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City | DAKOTA DUNES
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State | SD
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Zip | 57049
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Country | US
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Telephone | 605-232-6900
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Fax | 605-232-7007
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Provider Business Mailing Address
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Address Line | 317 DAKOTA DUNES BLVD STE J
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5341
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Country | US
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Telephone | 605-232-6900
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Fax | 605-232-7007
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | TIFFANY MARIE ELIAS
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Credential |
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Telephone | 605-232-6900
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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 | 551
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License Number State | SD
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