Provider Demographics
NPI:1437555182
Name:PILLEN OPTICAL INC
Entity Type:Organization
Organization Name:PILLEN OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:ABO/NCLE
Authorized Official - Phone:605-348-2323
Mailing Address - Street 1:409 KANSAS CITY ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8239
Mailing Address - Country:US
Mailing Address - Phone:605-348-2323
Mailing Address - Fax:605-348-6694
Practice Address - Street 1:409 KANSAS CITY ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8239
Practice Address - Country:US
Practice Address - Phone:605-348-2323
Practice Address - Fax:605-348-6694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9281160Medicaid