Provider Demographics
NPI:1396890471
Name:TKC OPTICAL, INC.
Entity type:Organization
Organization Name:TKC OPTICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-252-1519
Mailing Address - Street 1:229 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1401
Mailing Address - Country:US
Mailing Address - Phone:712-252-1519
Mailing Address - Fax:712-252-1916
Practice Address - Street 1:105 N SPLITROCK BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-1529
Practice Address - Country:US
Practice Address - Phone:605-582-2990
Practice Address - Fax:605-582-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD51-001332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
19011OtherAVESIS
SD9280082Medicaid
00013676OtherCOAST TO COAST
SD4997532OtherBCBS
9169072OtherDAKOTA CARE
637351-022765OtherPRFRD ONE ADMIN SERV
2100373OtherMEDICA
14272OtherSIOUX VALLEY HLTH PLN
21517OtherSPECTERA
121522OtherEYEMED
SD9280082Medicaid