| NPI | 1144759945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT JENSEN CEO 605-361-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| 207W00000X Ophthalmology (Licence: MT MED-PHYS-LIC-57511) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2021-01-07 |