MEDICARE: DAVID J PROSSER OD

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	152W00000X	Optometrist	472	SD

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

General Provider Information

NPI Number	:	1386623395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID J PROSSER OD

Provider Business Mailing Address
First Line	:	8918 RIDGE TRL
Second Line	:
City	:	STURGIS
State	:	SD
Zip	:	57785-2807
Country	:	US
Telephone Number	:	605-347-2549
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 HARMON ST
Second Line	:
City	:	STURGIS
State	:	SD
Zip	:	57785-2556
Country	:	US
Telephone Number	:	605-347-2666
Fax Number	:	605-347-5823

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	05/05/2010

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Directions to “ DAVID J PROSSER OD” Practice Location

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