Provider Demographics
NPI:1902256738
Name:KUIPERS, SARAH (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KUIPERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 MOUNT RUSHMORE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3603
Mailing Address - Country:US
Mailing Address - Phone:605-343-6617
Mailing Address - Fax:605-343-6621
Practice Address - Street 1:808 MOUNT RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3603
Practice Address - Country:US
Practice Address - Phone:605-343-6617
Practice Address - Fax:605-343-6621
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist