Provider Demographics
NPI:1356395156
Name:NORTHERN HILLS EYE CARE, PROF. L.L.C.
Entity type:Organization
Organization Name:NORTHERN HILLS EYE CARE, PROF. L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-347-2666
Mailing Address - Street 1:910 HARMON ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-2556
Mailing Address - Country:US
Mailing Address - Phone:605-347-2666
Mailing Address - Fax:605-347-5823
Practice Address - Street 1:910 HARMON ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-2556
Practice Address - Country:US
Practice Address - Phone:605-347-2666
Practice Address - Fax:605-347-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty