Provider Demographics
NPI:1386616480
Name:HURON EYE CLINIC PC
Entity type:Organization
Organization Name:HURON EYE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-352-4181
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-0948
Mailing Address - Country:US
Mailing Address - Phone:605-352-4181
Mailing Address - Fax:605-352-4189
Practice Address - Street 1:1288 DAKOTA AVE S
Practice Address - Street 2:STE 3
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-0948
Practice Address - Country:US
Practice Address - Phone:605-352-4181
Practice Address - Fax:605-352-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0041041OtherWELLMARK BCBS
SD9201065Medicaid
SD4851150001Medicare NSC
SDS41040Medicare ID - Type Unspecified
SD9201065Medicaid