Provider Demographics
NPI:1720190457
Name:SPEARFISH VISION WORKS, P.C.
Entity Type:Organization
Organization Name:SPEARFISH VISION WORKS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-484-1977
Mailing Address - Street 1:2825 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-3261
Mailing Address - Country:US
Mailing Address - Phone:605-642-3865
Mailing Address - Fax:605-642-3891
Practice Address - Street 1:2825 1ST AVE
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-3261
Practice Address - Country:US
Practice Address - Phone:605-642-3865
Practice Address - Fax:605-642-3891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1285657742OtherNPI (PERSONAL)