Vision Source Rapid City

LBN: Vision Source Rapid City
Vision Source Rapid City is an health care organization with primary practice located at 825 Columbus St Ste E , Rapid City SD 57701-4804. The organization recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as the primary health care specialty. Vision Source Rapid City can be contacted via phone (605) 343-4703, or through Ice, Dwayne Robert via phone (605) 343-4703.

Contact Information

Primary practice address
825 Columbus St Ste E Rapid City SD 57701-4804
Phone: (605) 343-4703
Fax: (605) 721-7201
Website:
Map and Directions
Authorized official contact:
Name: Ice, Dwayne Robert Doctor of Optometry (OD)
Phone: (605) 343-4703

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X

Profile Details

NPI number 1396342515
LBN Legal business name Vision Source Rapid City
DBA Doing business as
Authorized official Ice, Dwayne Robert Doctor of Optometry (OD)
Entity Organization
Organization subpart 1 No
Enumeration date Oct 1st, 2020
Last updated Oct 1st, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396342515 NPPES
South Dakota MEDICAID 9201450

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