Provider Demographics
NPI:1114205788
Name:TRI STATE VISION CARE, PROF LLC
Entity Type:Organization
Organization Name:TRI STATE VISION CARE, PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:SLOWEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-660-3896
Mailing Address - Street 1:2709 ABBOTT CIR
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 CORNHUSKER DR
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3924
Practice Address - Country:US
Practice Address - Phone:402-494-1498
Practice Address - Fax:402-494-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025994000Medicaid