Provider Demographics
NPI:1447664800
Name:SPEARFISH VISION WORKS, P.C.
Entity type:Organization
Organization Name:SPEARFISH VISION WORKS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-484-1977
Mailing Address - Street 1:1432 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BELLE FOURCHE
Mailing Address - State:SD
Mailing Address - Zip Code:57717-2304
Mailing Address - Country:US
Mailing Address - Phone:605-723-3937
Mailing Address - Fax:605-723-3940
Practice Address - Street 1:1432 MILL ST
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-2304
Practice Address - Country:US
Practice Address - Phone:605-723-3937
Practice Address - Fax:605-723-3940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPEARFISH VISION WORKS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty