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Individual

MS. ANNE M JORGENSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OPTICIAN

Contact information

Practice address
4900 S MINNESOTA AVE, SUITE 105, SIOUX FALLS, SD 57108-2865
(605) 759-2389
Mailing address
4900 S MINNESOTA AVE, SUITE 105, SIOUX FALLS, SD 57108-2865
(605) 759-2389

Taxonomy

Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
156FC0800X
Contact Lens Technician/Technologist
156FX1101X
Ophthalmic Assistant
156FX1201X
Optometric Assistant Technician
156FX1202X
Optometric Technician
156FX1800X
Optician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1026-7978-ST
SD DEPT. OF REVENUE
Enumeration date
10/25/2011
Last updated
11/11/2013
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