Provider Demographics
NPI:1124750294
Name:OPHTHALMOLOGY LTD
Entity type:Organization
Organization Name:OPHTHALMOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-731-5640
Mailing Address - Street 1:6601 S MINNESOTA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2564
Mailing Address - Country:US
Mailing Address - Phone:605-336-6294
Mailing Address - Fax:605-336-0266
Practice Address - Street 1:705 14TH AVE NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-6827
Practice Address - Country:US
Practice Address - Phone:605-886-7722
Practice Address - Fax:605-886-7723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPHTHALMOLOGY LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1010409Medicaid