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NPI Code Detail

MEDICARE: TRI STATE VISION CARE, PROF LLC

MEDICARE: TRI STATE VISION CARE, PROF LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1355NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114205788
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRI STATE VISION CARE, PROF LLC
Provider Business Mailing Address
First Line : 2709 ABBOTT CIR
Second Line :
City : YANKTON
State : SD
Zip : 57078-5330
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1601 CORNHUSKER DR
Second Line :
City : SOUTH SIOUX CITY
State : NE
Zip : 68776-3924
Country : US
Telephone Number : 402-494-1498
Fax Number : 402-494-1594
Authorized Official
Title or Position : OPTOMETRIST
Name : LAURA JOAN SLOWEY
Credential : O.D.
Telephone Number : 605-660-3896
Provider Enumeration Date : 07/29/2011
Last Update Date : 07/29/2011

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Directions to “TRI STATE VISION CARE, PROF LLC ” Practice Location

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