Organization
INDEPENDENT OPTICAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES A MORDHORST (OWNER)
(605) 343-6617
Entity
Organization
Contact information
Practice address
810 MOUNT RUSHMORE RD, RAPID CITY, SD 57701-3603
(605) 343-6617
(605) 343-6621
Mailing address
810 MOUNT RUSHMORE RD, RAPID CITY, SD 57701-3603
(605) 343-6617
(605) 343-6621
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9280150
—
SD
Enumeration date
06/06/2006
Last updated
05/07/2015
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