Individual
NANCY LYNN HETLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1900 N MAIN ST, MITCHELL, SD 57301-1160
(605) 996-7042
(605) 996-6627
Mailing address
2848 DAILEY DR, MITCHELL, SD 57301-5209
(605) 292-0648
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0040030744
BCBS PROVIDER NUMBER
IL
01
—
IL-9397
EYEMED PROVIDER NUMBER
IL
Enumeration date
10/12/2006
Last updated
07/08/2007
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