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NPI Code Detail

MEDICARE: SARAH HOUDEK OD

MEDICARE: SARAH HOUDEK 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
1152W00000XOptometrist766SD

General Provider Information

NPI Number : 1558974964
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH HOUDEK OD
Provider Business Mailing Address
First Line : 2020 JACKSON BLVD STE 1
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-3483
Country : US
Telephone Number : 605-342-0777
Fax Number : 605-342-7282
Provider Business Practice Location Address
First Line : 2020 JACKSON BLVD STE 1
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-3483
Country : US
Telephone Number : 605-342-0777
Fax Number : 605-342-7282
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2020
Last Update Date : 03/30/2022

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