Provider Demographics
NPI:1063479426
Name:CONROY EYE CARE PC
Entity Type:Organization
Organization Name:CONROY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-432-5730
Mailing Address - Street 1:411 S MAIN ST
Mailing Address - Street 2:PO BOX 471
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-2424
Mailing Address - Country:US
Mailing Address - Phone:605-432-5730
Mailing Address - Fax:605-432-4324
Practice Address - Street 1:411 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-2424
Practice Address - Country:US
Practice Address - Phone:605-432-5730
Practice Address - Fax:605-432-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD491152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9202533Medicaid
MN358723100OtherMEDICAID
MN358723100OtherMEDICAID
SD4645120002Medicare NSC
SDS40771Medicare PIN
MN358723100OtherMEDICAID