Wiederholt, Nathan Henry
Wiederholt, Nathan Henry is an sole proprietor health care provider with primary practice located at 322 Mount Rushmore Rd Suite 120, Custer SD 57730-1936. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Wiederholt, Nathan Henry can be contacted via phone (605) 673-2716.Contact Information
Primary practice address
322 Mount Rushmore Rd Suite 120
Custer SD 57730-1936
Phone: (605) 673-2716
Fax: (605) 673-2017
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 656 | South Dakota |
Profile Details
| NPI number | 1447414461 |
|---|---|
| LBN Legal business name | Wiederholt, Nathan Henry |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 18th, 2008 |
| Last updated | Jun 16th, 2010 - about 15 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1447414461 | NPPES |
| South Dakota | MEDICAID | 9203883 |
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