| NPI | 1992393250 |
|---|---|
| Former Legal Business Name | VISION SOURCE RAPID CITY |
| Entity Type | Organization |
| Authorized Contact | BARBARA ICE Office Manager 605-343-4703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Enumeration Date | 2021-01-04 |
| Last Update Date | 2021-01-04 |