MEDICARE: SPEARFISH EYE CARE CENTER

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
1	156FX1800X	Optician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0077585	OTHER	SD	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1144256587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEARFISH EYE CARE CENTER

Provider Business Mailing Address
First Line	:	1710 NORTH AVE
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-1218
Country	:	US
Telephone Number	:	605-642-8430
Fax Number	:	605-642-8185

Provider Business Practice Location Address
First Line	:	1710 NORTH AVE
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-1218
Country	:	US
Telephone Number	:	605-642-8430
Fax Number	:	605-642-8185

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL RICHEY
Credential	:	OD
Telephone Number	:	605-642-8480

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	09/23/2008

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1609721463 — GENAVEVE HOPE THOMSON LCSW
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1346244332 — KAREN M SCHLEEHAUF MD
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Directions to “SPEARFISH EYE CARE CENTER ” Practice Location

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