MEDICARE: NICOLE R GROSSHUESCH COA

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	156FX1202X	Optometric Technician
2	156FX1101X	Ophthalmic Assistant

General Provider Information

NPI Number	:	1386599793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE R GROSSHUESCH COA

Provider Business Mailing Address
First Line	:	6216 W 66TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-2483
Country	:	US
Telephone Number	:	605-336-3230
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 W 22ND ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1305
Country	:	US
Telephone Number	:	605-336-3230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ NICOLE R GROSSHUESCH COA” Practice Location

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