Organization Name: | BLACK HILLS OPTICAL LLP |
NPI Number: | 1043435746 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DECEMBER WHITE (OPTICIAN) |
Mailing Address: | 1830 5th Ave Belle Fourche |
State: | SD US |
Postal Code: | 57717 |
Phone Number: | 6058924411 |
Fax Number: | |
NPI Enumeration Date: | 04/16/2007 |
NPI Last Update Date: | 10/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |