Ice, Dwayne Robert

Ice, Dwayne Robert is an sole proprietor health care provider with primary practice located at 825 Columbus St Ste E, Rapid City SD 57701-4803. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Ice, Dwayne Robert can be contacted via phone (605) 343-4703.

Contact Information

Primary practice address
825 Columbus St Ste E Rapid City SD 57701-4803
Phone: (605) 343-4703
Fax: (605) 721-7201
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X T-149 South Dakota

Profile Details

NPI number 1447362074
LBN Legal business name Ice, Dwayne Robert
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 31st, 2006
Last updated Sep 4th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447362074 NPPES
South Dakota MEDICAID 9201450

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