Organization
PREMIER FAMILY EYE CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATHAN WIEDERHOLT O.D. (OWNER)
(605) 673-2716
Entity
Organization
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
04/30/2009
Last updated
06/29/2010
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