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NPI Code Detail

MEDICARE: 20/20 EYE CANDY, INC.

MEDICARE: 20/20 EYE CANDY, INC.
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
1156F00000XTechnician/Technologist
2156FC0800XContact Lens Technician/Technologist
3156FX1100XOphthalmic Technician/Technologist
4156FX1101XOphthalmic Assistant
5156FX1201XOptometric Assistant Technician
6156FX1202XOptometric Technician
7152WC0802XCorneal and Contact Management Optometrist672SD
8152WP0200XPediatric Optometrist672SD
9152W00000XOptometrist672SD
10156FX1800XOptician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11790061539OTHERSDINDIVIDUAL NPI NUMBER
21026-7978-STOTHERSDSD DEPT. OF REVENUE
31447590187OTHERSDINDIVIDUAL NPI NUMBER
41326477316OTHERSDINDIVIDUAL NPI NUMBER
51700174273OTHERSDINDIVIDUAL NPI NUMBER

General Provider Information

NPI Number : 1700126448
Entity Type Code : Organization
Provider Name (Legal Business Name) : 20/20 EYE CANDY, INC.
Provider Business Mailing Address
First Line : 4900 S MINNESOTA AVE
Second Line : SUITE 105
City : SIOUX FALLS
State : SD
Zip : 57108-2865
Country : US
Telephone Number : 605-759-2389
Fax Number :
Provider Business Practice Location Address
First Line : 4900 S MINNESOTA AVE
Second Line : SUITE 105
City : SIOUX FALLS
State : SD
Zip : 57108-2865
Country : US
Telephone Number : 605-759-2389
Fax Number :
Authorized Official
Title or Position : CO-OWNER
Name : KRISTA VALARIE SMIT
Credential : OPTICIAN
Telephone Number : 605-759-2389
Provider Enumeration Date : 02/17/2013
Last Update Date : 11/14/2013

Similar Medicare Providers

1447337068 — STEPHANIE GANSCHOW PHARMD
Practice Location Address:
2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106
Practice Phone: 605-373-0100
Practice Fax:
1790061539 — MS. ANNE M JORGENSEN OPTICIAN
Practice Location Address:
4900 S MINNESOTA AVE , SUITE 105
SIOUX FALLS, SD
57108-2865
Practice Phone: 605-759-2389
Practice Fax:
1447590187 — MARY CATHERINE JORGENSEN OPTICIAN
Practice Location Address:
4900 S MINNESOTA AVE , SUITE 105
SIOUX FALLS, SD
57108-2865
Practice Phone: 605-759-2389
Practice Fax:
1982030029 — JENNIFER MARIE ZERFAS MA, LPC
Practice Location Address:
4900 S MINNESOTA AVE STE 101
SIOUX FALLS, SD
57108-2865
Practice Phone: 605-501-8357
Practice Fax:
1326477316 — KRISTA VALARIE SMIT OPTICIAN
Practice Location Address:
4900 S MINNESOTA AVE , SUITE 105
SIOUX FALLS, SD
57108-2865
Practice Phone: 600-575-9238
Practice Fax:
1437791720 — BREA GRUENEICH MS, NCC, LPC-MH, QMH
Practice Location Address:
4900 S MINNESOTA AVE STE 101
SIOUX FALLS, SD
57108-2865
Practice Phone: 605-467-7424
Practice Fax: 605-309-7917

Directions to “20/20 EYE CANDY, INC. ” Practice Location

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