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General NPI Number Information
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NPI Number | 1770884025
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Entity Type | Organization
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Legal Business Name | CP TWITERO, PC
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 606 20TH ST S
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City | BROOKINGS
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State | SD
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Zip | 57006-4671
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Country | US
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Telephone | 605-627-1212
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Fax | 605-627-1313
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Provider Business Mailing Address
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Address Line | 606 20TH ST S
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City | BROOKINGS
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State | SD
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Zip | 57006-4671
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Country | US
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Telephone | 605-627-1212
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Fax | 605-627-1313
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Authorized Official
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Title or Position | COO
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Name | JENNA KROGMAN
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Credential |
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Telephone | 402-301-7765
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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 | T477
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License Number State | SD
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