Provider Demographics
NPI:1174502330
Name:PORISCH, ERIC D (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:PORISCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2718
Mailing Address - Country:US
Mailing Address - Phone:605-341-5644
Mailing Address - Fax:605-341-5450
Practice Address - Street 1:605 SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2718
Practice Address - Country:US
Practice Address - Phone:605-341-5644
Practice Address - Fax:605-341-5450
Is Sole Proprietor?:No
Enumeration Date:2006-01-15
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD604152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD11336062OtherCAQH
SD9203370Medicaid
SDS100185OtherMEDICARE ID
SDS100185OtherMEDICARE ID
SD11336062OtherCAQH