Provider Demographics
NPI:1316119738
Name:PIETZ-COATS OPTOMETRY INC
Entity type:Organization
Organization Name:PIETZ-COATS OPTOMETRY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:PIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-692-5173
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-0785
Mailing Address - Country:US
Mailing Address - Phone:605-692-5173
Mailing Address - Fax:605-692-6710
Practice Address - Street 1:112 22ND AVE S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2600
Practice Address - Country:US
Practice Address - Phone:605-692-5173
Practice Address - Fax:605-692-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD597152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6125860001Medicare NSC