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Organization
LG OPTICAL ENTERPRISES
Active
Organization
LG OPTICAL ENTERPRISES
Active
Other names
Total Eyewear
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN GANNON (OWNER)
(605) 692-8262
Entity
Organization
Contact information
Practice address
952 22ND AVE S, BROOKINGS, SD 57006-2830
(605) 692-8262
(605) 692-9805
Mailing address
952 22ND AVE S, BROOKINGS, SD 57006-2830
(605) 692-8262
(605) 692-9805
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
05001593786886EST001
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111835
EYEMED
SD
01
—
39879
AVESIS
SD
01
—
4997613
BLUE CROSS BLUE SHIELD
SD
01
—
9226299
DAKOTA CARE
SD
05
—
9281452
—
SD
Enumeration date
03/04/2008
Last updated
05/04/2015
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