Provider Demographics
NPI:1538343934
Name:HURON VISION CENTER
Entity type:Organization
Organization Name:HURON VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-352-8511
Mailing Address - Street 1:1712 DAKOTA AVE S
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-4024
Mailing Address - Country:US
Mailing Address - Phone:605-352-8511
Mailing Address - Fax:
Practice Address - Street 1:1712 DAKOTA AVE S
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-4024
Practice Address - Country:US
Practice Address - Phone:605-352-8511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT101152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9200012Medicaid
SDS41319OtherGROUP LEGACY NUMBER
SD0642290001Medicare NSC
SD41320Medicare PIN
SD9200012Medicaid