Individual
DR. NATHAN HENRY WIEDERHOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
322 MOUNT RUSHMORE RD, SUITE 120, CUSTER, SD 57730-1936
(605) 673-2716
(605) 673-2017
Mailing address
322 MOUNT RUSHMORE RD, SUITE 120, CUSTER, SD 57730-1936
(605) 673-2716
(605) 673-2017
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
656
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9203883
—
SD
Enumeration date
07/18/2008
Last updated
06/16/2010
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