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3307 7th Ave Se Ste 105, Aberdeen, SD 57401-6613 | |
(605) 225-7677 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Eyewear Supplier |
Location | 3307 7th Ave Se Ste 105, Aberdeen, 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 |
---|---|---|---|
1588220958 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Provider Name | Michael J Johnson |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1548204191 PECOS PAC ID: 4284690710 Enrollment ID: I20041207000578 |
Provider Name | Jason Arthur Lorenz |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1619918216 PECOS PAC ID: 2163435280 Enrollment ID: I20060713000064 |
Provider Name | Kendra I Ott |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1326116930 PECOS PAC ID: 1456449404 Enrollment ID: I20071108000714 |
Provider Name | Jordan Langel |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1063030203 PECOS PAC ID: 6103241773 Enrollment ID: I20200730001916 |
Mailing Address | Practice Location Address |
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Po Box 19060, Green Bay, WI 54307-9060 Ph: () - | 3307 7th Ave Se Ste 105, Aberdeen, SD 57401-6613 Ph: (605) 225-7677 |