Provider Demographics
NPI:1275527475
Name:BRINK, TIFFANY JOY (OD)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:JOY
Last Name:BRINK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:TIFFANY
Other - Middle Name:JOY
Other - Last Name:BRINK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2325 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5046
Mailing Address - Country:US
Mailing Address - Phone:605-275-6100
Mailing Address - Fax:605-275-6105
Practice Address - Street 1:2325 W 57TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5046
Practice Address - Country:US
Practice Address - Phone:605-275-6100
Practice Address - Fax:605-275-6105
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT0568152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0007147OtherBLUE CROSS BLUE SHIELD
SD9203200Medicaid
SD23017OtherSIOUX VALLEY HEALTH PLAN
U80573Medicare UPIN
SD7147Medicare ID - Type Unspecified