Provider Demographics
NPI:1013756899
Name:HAWKEYE EXACT SD 1 PLLC
Entity type:Organization
Organization Name:HAWKEYE EXACT SD 1 PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WIERTZEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-940-6200
Mailing Address - Street 1:11 SHRINER ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-1155
Mailing Address - Country:US
Mailing Address - Phone:605-624-2020
Mailing Address - Fax:
Practice Address - Street 1:11 SHRINER ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-1155
Practice Address - Country:US
Practice Address - Phone:605-624-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty