Provider Demographics
NPI:1003305772
Name:SIVESIND, TIMS & CLARKE, PROF. L.L.C.
Entity Type:Organization
Organization Name:SIVESIND, TIMS & CLARKE, PROF. L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-400-3939
Mailing Address - Street 1:2210 W 69TH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5614
Mailing Address - Country:US
Mailing Address - Phone:605-331-2020
Mailing Address - Fax:605-638-9649
Practice Address - Street 1:2210 W 69TH ST STE 160
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5614
Practice Address - Country:US
Practice Address - Phone:605-331-2020
Practice Address - Fax:605-638-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty