Provider Demographics
NPI:1902479033
Name:EYEWEAR CARE
Entity Type:Organization
Organization Name:EYEWEAR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KOBERNUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-421-1818
Mailing Address - Street 1:43318 SD HIGHWAY 38
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:SD
Mailing Address - Zip Code:57374-5403
Mailing Address - Country:US
Mailing Address - Phone:605-421-1818
Mailing Address - Fax:
Practice Address - Street 1:43318 SD HIGHWAY 38
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:SD
Practice Address - Zip Code:57374-5403
Practice Address - Country:US
Practice Address - Phone:605-421-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier