Provider Demographics
NPI:1053592394
Name:HAWKEYE CLINIC OF SOUTH DAKOTA
Entity type:Organization
Organization Name:HAWKEYE CLINIC OF SOUTH DAKOTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-232-6900
Mailing Address - Street 1:317 DAKOTA DUNES BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5341
Mailing Address - Country:US
Mailing Address - Phone:605-232-6900
Mailing Address - Fax:605-232-7007
Practice Address - Street 1:305 DAKOTA DUNES BLVD
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049
Practice Address - Country:US
Practice Address - Phone:605-232-6900
Practice Address - Fax:605-232-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS40850Medicare PIN