Provider Demographics
NPI:1689687683
Name:OPTICAL WORKS INC
Entity type:Organization
Organization Name:OPTICAL WORKS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MINTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-341-4225
Mailing Address - Street 1:2800 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7374
Mailing Address - Country:US
Mailing Address - Phone:605-341-4225
Mailing Address - Fax:605-341-0945
Practice Address - Street 1:2800 3RD ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7374
Practice Address - Country:US
Practice Address - Phone:605-341-4225
Practice Address - Fax:605-341-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9280110Medicaid
SD9280110Medicaid