Provider Demographics
NPI:1700126448
Name:20/20 EYE CANDY, INC.
Entity type:Organization
Organization Name:20/20 EYE CANDY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:VALARIE
Authorized Official - Last Name:SMIT
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:605-759-2389
Mailing Address - Street 1:4900 S MINNESOTA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2865
Mailing Address - Country:US
Mailing Address - Phone:605-759-2389
Mailing Address - Fax:
Practice Address - Street 1:4900 S MINNESOTA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2865
Practice Address - Country:US
Practice Address - Phone:605-759-2389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-17
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X, 156FC0800X, 156FX1100X, 156FX1101X, 156FX1201X, 156FX1202X, 156FX1800X
SD672152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic AssistantGroup - Single Specialty
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric AssistantGroup - Single Specialty
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1790061539OtherINDIVIDUAL NPI NUMBER
SD1026-7978-STOtherSD DEPT. OF REVENUE
SD1447590187OtherINDIVIDUAL NPI NUMBER
SD1326477316OtherINDIVIDUAL NPI NUMBER
SD1700174273OtherINDIVIDUAL NPI NUMBER