MEDICARE: PAULA SORENSEN O.D.

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	517	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S41393	OTHER	SD	MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831206200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA SORENSEN O.D.

Provider Business Mailing Address
First Line	:	2626 W MAIN ST
Second Line	:	SUITE 4
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2497
Country	:	US
Telephone Number	:	605-399-3811
Fax Number	:	605-399-3845

Provider Business Practice Location Address
First Line	:	2626 W MAIN ST
Second Line	:	SUITE 4
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2497
Country	:	US
Telephone Number	:	605-399-3811
Fax Number	:	605-399-3845

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	01/16/2013

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Directions to “ PAULA SORENSEN O.D.” Practice Location

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