Provider Demographics
NPI:1538309604
Name:OUTPOST OPTICAL INC
Entity Type:Organization
Organization Name:OUTPOST OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:B
Authorized Official - Last Name:RABBITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-232-3937
Mailing Address - Street 1:PO BOX 1993
Mailing Address - Street 2:
Mailing Address - City:NORTH SIOUX CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57049-1993
Mailing Address - Country:US
Mailing Address - Phone:605-232-3937
Mailing Address - Fax:605-235-1350
Practice Address - Street 1:206 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NORTH SIOUX CITY
Practice Address - State:SD
Practice Address - Zip Code:57049-3170
Practice Address - Country:US
Practice Address - Phone:605-232-3937
Practice Address - Fax:605-235-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9200623Medicaid
SD0005536OtherBLUE CROSS BLUE SHIELD
20033OtherSPECTERA
NE100249906-00Medicaid
29577OtherAVESIS
IA0541748Medicaid
SDS103720Medicare PIN
SD0005536OtherBLUE CROSS BLUE SHIELD