The Optical Shop Inc.

Primary specialty

OpticianTaxonomy code 156FX1800X

License

05001EST001 Issued in SD

Legal business name

THE OPTICAL SHOP INC.

Practice address

112 22ND Ave S
Brookings, SD 57006-2600

Phone

(605) 692-5173

Fax

(605) 692-6710

NPI assigned

Nov 28, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Tom Anderson, A.B.O.C.

Title

Owner

Phone

(605) 692-5173

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1063588374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 22ND AVE S",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062600",
            "telephone_number": "605-692-5173",
            "fax_number": "605-692-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 22ND AVE S",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062600",
            "telephone_number": "605-692-5173",
            "fax_number": "605-692-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE OPTICAL SHOP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-692-5173",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "A.B.O.C."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "SD",
            "license": "05001EST001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9280970",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optician in Brookings, SD
• Providers in Brookings, SD by specialty
• Optician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.