Provider Demographics
NPI:1790061539
Name:JORGENSEN, ANNE M (OPTICIAN)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:M
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MINNESOTA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2865
Mailing Address - Country:US
Mailing Address - Phone:605-759-2389
Mailing Address - Fax:
Practice Address - Street 1:4900 S MINNESOTA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2865
Practice Address - Country:US
Practice Address - Phone:605-759-2389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric Assistant
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1026-7978-STOtherSD DEPT. OF REVENUE