Provider Demographics
NPI:1285672246
Name:SIVESIND, JOHN WESLEY JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WESLEY JOSEPH
Last Name:SIVESIND
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 1:5521 E ARROWHEAD PKWY
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-0400
Mailing Address - Country:US
Mailing Address - Phone:605-334-7737
Mailing Address - Fax:605-367-3255
Practice Address - Street 1:5521 E ARROWHEAD PKWY
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-0400
Practice Address - Country:US
Practice Address - Phone:605-334-7737
Practice Address - Fax:605-367-3255
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD610152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9203460Medicaid
SD9203460Medicaid
SD100470Medicare ID - Type UnspecifiedOPTOMETRIST