Provider Demographics
NPI:1235592841
Name:4 EYES VISION CARE, PLLC
Entity type:Organization
Organization Name:4 EYES VISION CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-840-4812
Mailing Address - Street 1:213 PHILIP DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 N MAPLE AVE
Practice Address - Street 2:ATTN: OPTOMETRIST AT JCPENNEY OPTICAL
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7854
Practice Address - Country:US
Practice Address - Phone:605-341-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD 696152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty