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General NPI Number Information
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NPI Number | 1154586014
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Entity Type | Organization
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Legal Business Name | CROUCH VISION CLINIC
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 5118 W 26TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57106-3520
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Country | US
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Telephone | 605-339-1939
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Fax | 605-330-0252
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Provider Business Mailing Address
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Address Line | 5118 W 26TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57106-3520
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Country | US
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Telephone | 605-339-1939
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Fax | 605-330-0252
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Authorized Official
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Title or Position | INSURANCE & BILLING COORDINATOR
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Name | VIRJEAN L FEJFAR
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Credential |
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Telephone | 605-339-1939
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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 | 527
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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 | 526
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License Number State | SD
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