Individual
DR. DWAYNE ROBERT ICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
825 COLUMBUS ST, STE E, RAPID CITY, SD 57701-4803
(605) 343-4703
(605) 721-7201
Mailing address
825 COLUMBUS ST, STE E, RAPID CITY, SD 57701-4803
(605) 343-4703
(605) 721-7201
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T-149
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9201450
—
SD
Enumeration date
08/31/2006
Last updated
09/04/2013
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