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General NPI Number Information
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NPI Number | 1134188600
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Entity Type | Organization
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Legal Business Name | DAKOTA VISION CENTER, LLC
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 5012 S BUR OAK PL
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2228
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Country | US
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Telephone | 605-361-1680
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Fax | 605-361-1590
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Provider Business Mailing Address
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Address Line | 5012 S BUR OAK PL
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2228
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Country | US
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Telephone | 605-361-1680
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Fax | 605-361-1590
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. VANCE EVAN ANKRUM
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Credential | O.D.
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Telephone | 605-361-1680
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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 | T-473
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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 | T-462
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T-155
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License Number State | SD
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