Provider Demographics
NPI:1154586014
Name:CROUCH VISION CLINIC
Entity type:Organization
Organization Name:CROUCH VISION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE & BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRJEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FEJFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-339-1939
Mailing Address - Street 1:5118 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3520
Mailing Address - Country:US
Mailing Address - Phone:605-339-1939
Mailing Address - Fax:605-330-0252
Practice Address - Street 1:5118 W 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3520
Practice Address - Country:US
Practice Address - Phone:605-339-1939
Practice Address - Fax:605-330-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD526152W00000X
SD527152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS4140Medicare PIN