Organization
THE OPTICAL SHOP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM ANDERSON A.B.O.C. (OWNER)
(605) 692-5173
Entity
Organization
Contact information
Practice address
112 22ND AVE S, BROOKINGS, SD 57006-2600
(605) 692-5173
(605) 692-6710
Mailing address
112 22ND AVE S, BROOKINGS, SD 57006-2600
(605) 692-5173
(605) 692-6710
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
05001EST001
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9280970
—
SD
Enumeration date
11/28/2006
Last updated
07/21/2022
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