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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
About Stedi
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