Provider Demographics
NPI:1306202700
Name:INFINITY EYECARE, PC
Entity Type:Organization
Organization Name:INFINITY EYECARE, PC
Other - Org Name:INFINITY EYECARE, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-853-9407
Mailing Address - Street 1:5734 SHERIDAN LAKE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8811
Mailing Address - Country:US
Mailing Address - Phone:605-342-0258
Mailing Address - Fax:605-342-0209
Practice Address - Street 1:5734 SHERIDAN LAKE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8811
Practice Address - Country:US
Practice Address - Phone:605-342-0258
Practice Address - Fax:605-342-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty