Organization
VISION SOURCE SPECIALISTS, PROF. L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAWN WATTENHOFER O.D. (PARTNER/OWNER)
(605) 399-3937
Entity
Organization
Contact information
Practice address
318 MOUNT RUSHMORE RD, STE A, RAPID CITY, SD 57701-2769
(605) 399-3937
(605) 399-5910
Mailing address
318 MOUNT RUSHMORE RD, STE A, RAPID CITY, SD 57701-2769
(605) 399-3937
(605) 399-5910
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
SD0553
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124109848
NPI
SD
01
—
1154390573
NPI
SD
01
—
1245344001
NPI
SD
01
—
1679653240
NPI
SD
Enumeration date
09/10/2014
Last updated
09/11/2014
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