Premier Family Eye Care, Pc | |
322 Mount Rushmore Rd, Suite 120, Custer, SD 57730-1936 | |
(605) 673-2716 | |
(605) 673-2017 |
Full Name | Premier Family Eye Care, Pc |
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Type | Facility |
Speciality | Optometrist |
Location | 322 Mount Rushmore Rd, Custer, South Dakota |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1699919852 | NPI | - | NPPES |
9203883 | Medicaid | SD |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | 656 (South Dakota) | Primary |
Provider Name | Nathan H Wiederholt |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1447414461 PECOS PAC ID: 4688740665 Enrollment ID: I20080828000233 |
Mailing Address | Practice Location Address |
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Premier Family Eye Care, Pc 322 Mount Rushmore Rd, Suite 120, Custer, SD 57730-1936 Ph: (605) 673-2716 | Premier Family Eye Care, Pc 322 Mount Rushmore Rd, Suite 120, Custer, SD 57730-1936 Ph: (605) 673-2716 |
Vernon Wong, OD Optometrist Medicare: Not Enrolled in Medicare Practice Location: 25229 Pinto Ln, Custer, SD 57730 Phone: 605-673-5663 | |
Dr. Nathan Henry Wiederholt, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 322 Mount Rushmore Rd, Suite 120, Custer, SD 57730 Phone: 605-673-2716 Fax: 605-673-2017 |