MEDICARE: MS. ANNE M JORGENSEN OPTICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	156FX1800X	Optician
2	156F00000X	Technician/Technologist
3	156FC0800X	Contact Lens Technician/Technologist
4	156FX1101X	Ophthalmic Assistant
5	156FX1201X	Optometric Assistant Technician
6	156FX1202X	Optometric Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1026-7978-ST	OTHER		SD DEPT. OF REVENUE

General Provider Information

NPI Number	:	1790061539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE M JORGENSEN OPTICIAN

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	11/11/2013

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