Provider Demographics
NPI:1699768010
Name:WEICHLER, PAULINE SUSAN (OD)
Entity type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:SUSAN
Last Name:WEICHLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2518
Mailing Address - Country:US
Mailing Address - Phone:605-718-7550
Mailing Address - Fax:605-718-7551
Practice Address - Street 1:685 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2518
Practice Address - Country:US
Practice Address - Phone:605-718-7550
Practice Address - Fax:605-718-7551
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7992560OtherBCBS
90000106357702A002OtherTRI CARE
SD9202623Medicaid
0040327OtherBCBS WELLMARK
484OtherDAKOTACARE
SD9202625Medicaid
S40327Medicare PIN
90000106357702A002OtherTRI CARE
SDS102166Medicare PIN
D31677Medicare UPIN