Provider Demographics
NPI:1609855980
Name:HERSCH, TAMMY KAY (OD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:KAY
Last Name:HERSCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 NORTH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1541
Mailing Address - Country:US
Mailing Address - Phone:605-642-0390
Mailing Address - Fax:605-642-0388
Practice Address - Street 1:1420 NORTH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1543
Practice Address - Country:US
Practice Address - Phone:605-642-0390
Practice Address - Fax:605-642-0388
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD508152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9202850Medicaid
SD43422Medicare UPIN
SD9202850Medicaid