MEDICARE: DR. VANCE EVAN ANKRUM 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	T-473	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	:	1881653442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANCE EVAN ANKRUM O.D.

Provider Business Mailing Address
First Line	:	5012 S BUR OAK PL
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2228
Country	:	US
Telephone Number	:	605-361-1680
Fax Number	:	605-361-1590

Provider Business Practice Location Address
First Line	:	5012 S BUR OAK PL
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2228
Country	:	US
Telephone Number	:	605-361-1680
Fax Number	:	605-361-1590

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	06/17/2020

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