Provider Demographics
NPI:1588279376
Name:DAKOTA VISION CENTER, LLC
Entity type:Organization
Organization Name:DAKOTA VISION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-361-1680
Mailing Address - Street 1:5012 S BUR OAK PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2228
Mailing Address - Country:US
Mailing Address - Phone:605-361-1680
Mailing Address - Fax:605-361-1590
Practice Address - Street 1:1100 S HIGHLINE PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-1001
Practice Address - Country:US
Practice Address - Phone:605-271-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAKOTA VISION CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty