Provider Demographics
NPI:1861694812
Name:VERMILLION VISION CLINIC, PC
Entity type:Organization
Organization Name:VERMILLION VISION CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEJONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-624-4291
Mailing Address - Street 1:120 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3036
Mailing Address - Country:US
Mailing Address - Phone:605-624-4291
Mailing Address - Fax:605-624-6822
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3036
Practice Address - Country:US
Practice Address - Phone:605-624-4291
Practice Address - Fax:605-624-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD578152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD11321OtherAVERA HEALTH
SD9219420OtherDAKOTACARE GROUP
SDOP2175OtherEYEMED
SD32866OtherSANFORD HEALTH GROUP
SD9200863Medicaid
399493OtherCOVENTRY HEALTH CARE OF IOWA
SD238521OtherMIDLANDS CHOICE, AETNA, CIGNA
SD4995791OtherBLUE SHIELD GROUP
SD2100851OtherMEDICA UNITED HEALTHCARE
SD6056244291OtherVSP
399493OtherCOVENTRY HEALTH CARE OF IOWA
SD11321OtherAVERA HEALTH
SDU85806Medicare UPIN
SD9200863Medicaid
SD41823Medicare PIN
SD2100851OtherMEDICA UNITED HEALTHCARE