Vance Thompson Vision Clinic Prof LLC
Organization Active NPI Ophthalmology Physician · Sioux Falls, SD
NPI 1205193554 · NPPES record last updated Jan 27, 2025
Key facts
- NPI
- 1205193554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- Legal business name
- VANCE THOMPSON VISION CLINIC PROF LLC
- Practice address
- 3101 W 57TH St
Sioux Falls, SD 57108-3162 - Phone
- (605) 361-3937
- Fax
- (605) 371-7199
- NPI assigned
- Apr 11, 2012
- Organization subpart
- No
Authorized official
- Name
- John Palmer Berdahl, MD
- Title
- Owner
- Phone
- (605) 361-3937
Other NPIs on the same Medicare enrollment 1
Practitioners 47
-
John Palmer Berdahl, M.D.
-
Mitchel Ibach, O.D.
-
Hilary Lynn Olinger, CNP
-
Samantha A Rivet, OD
-
Justin A Schweitzer, O.D.
-
John Glenn Goertz, O.D.
-
Zachary Goodwin Keenum, M.D.
-
Brooke Marie Messer, O.D.
-
Spenser Joel Morton, M.D.
-
Cullen Dean Ryburn, M.D.
-
Kelly Jo Sieps, O.D.
-
Richard Stangler, MD
-
Mathew Thomas Walker, O.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D2317266 | Vance Thompson Vision Clinic Prof, LLC | Certificate of waiver | Jan 20, 2027 |
| 16D2313288 | Vance Thompson Vision Clinic Prof LLC | Certificate of waiver | Oct 28, 2026 |
| 24D2276591 | Vance Thompson Vision Clinic Prof LLC | Certificate of waiver | Feb 9, 2027 |
| 28D2151901 | Vance Thompson Vision Clinic Prof LLC | Certificate of waiver | Jul 30, 2026 |
| 28D2203471 | Vance Thompson Vision Clinic Prof LLC | Certificate of waiver | Dec 2, 2026 |
| 43D1023895 | Vance Thompson Vision Clinic Prof LLC | Certificate of waiver | Jan 31, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (7 enrollments) in SD, NE, MN, MT, ND, IA, CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130410000524 | SD | Part B Supplier - Clinic/Group Practice | 1153567441 |
Receives reassigned benefits from 19 practitioners Practice locations: Sioux Falls, SD |
| O20201204000096 | NE | Part B Supplier - Clinic/Group Practice | 1153567441 |
Receives reassigned benefits from 11 practitioners Practice locations: Omaha, NE; South Sioux City, NE |
| O20210615000964 | MN | Part B Supplier - Clinic/Group Practice | 1153567441 |
Receives reassigned benefits from 7 practitioners 1 other NPI on this enrollment Practice locations: Alexandria, MN; Ortonville, MN |
| O20220414001408 | MT | Part B Supplier - Clinic/Group Practice | 1153567441 |
Receives reassigned benefits from 5 practitioners Practice locations: Billings, MT; Bozeman, MT |
| O20220418001307 | ND | Part B Supplier - Clinic/Group Practice | 1153567441 |
Receives reassigned benefits from 6 practitioners Practice locations: West Fargo, ND |
| O20250102001582 | IA | Part B Supplier - Clinic/Group Practice | 1153567441 |
Receives reassigned benefits from 3 practitioners Practice locations: Cedar Rapids, IA |
| O20250203001432 | CO | Part B Supplier - Clinic/Group Practice | 1153567441 |
Receives reassigned benefits from 1 practitioner Practice locations: Loveland, CO |
National Provider Directory
Locations
2975 Ginnala Dr
Ste 120
Loveland, CO 80538
Phone (970) 624-5170
2600 Jefferson St
Ste 100
Alexandria, MN 56308
Phone (320) 335-2167
2825 W Main St
Ste 2C
Bozeman, MT 59718
Phone (406) 219-0700
354 23rd Ave E
West Fargo, ND 58078
Phone (701) 566-5390
11819 Miracle Hills Dr
Omaha, NE 68154
Phone (402) 201-2373
Interoperability endpoints
- ksieps@vtv.intellechartdirect.net
- nmorales@vtv.intellechartdirect.net
- mbosh@vtv.intellechartdirect.net
- jward@vtv.intellechartdirect.net
- rstangler@vtv.intellechartdirect.net
- cryburn@vtv.intellechartdirect.net
- kmechels@vtv.intellechartdirect.net
- awenner@vtv.intellechartdirect.net
- khilsabeck@vtv.intellechartdirect.net
- bkramer@vtv.intellechartdirect.net
- jnelson@vtv.intellechartdirect.net
- tferguson@vtv.intellechartdirect.net
- lprovencher@vtv.intellechartdirect.net
- cpurser@vtv.intellechartdirect.net
- srivet@vtv.intellechartdirect.net
- cwilson@vtv.intellechartdirect.net
- kkarpuk@vtv.intellechartdirect.net
- zkeenum@vtv.intellechartdirect.net
- ganderson@vtv.intellechartdirect.net
- kmohr@vtv.intellechartdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | SD | ||
| Ophthalmology Physician |
207W00000X | SD | Yes |
Addresses
Primary practice location
3101 W 57TH St
Sioux Falls, SD 57108-3162
Mailing address
3101 W 57TH St
Sioux Falls, SD 57108-3162
Phone (605) 361-3937
Other practice location 1
4909 S 118th St
Omaha, NE 68137-2213
Phone (402) 506-9970
Other practice location 2
1925 N 22nd Ave Ste 201
Bozeman, MT 59718-7020
Phone (406) 219-0700
Other practice location 3
1747 Poly Dr
Billings, MT 59102-1728
Phone (406) 294-1994
Other practice location 4
201 E 4th St
South Sioux City, NE 68776-9916
Phone (531) 625-3941
Other practice location 5
301 Flynn Dr
Milbank, SD 57252-1508
Phone (605) 432-4538
Other practice location 6
450 Eastvold Ave
Ortonville, MN 56278-1252
Phone (320) 839-2502
Other practice location 7
354 23rd Ave E
West Fargo, ND 58078-7820
Phone (701) 566-5390
Other practice location 8
2600 Jefferson St Ste 200
Alexandria, MN 56308-3410
Phone (320) 762-2166
Other practice location 9
1136 H Ave NE
Cedar Rapids, IA 52402-4624
Phone (833) 440-7977
Other practice location 10
2975 Ginnala Dr Ste 120
Loveland, CO 80538-3300
Phone (970) 775-5453
Other names
- Vance Thompson Vision
Other providers in Sioux Falls, SD
- Clayton Gerald Vanbalen
- Michelle Linnae Vanbeek
- Cole Vanbockern
- Darah Vanbockern
- Sarah Marie Vanbriesen
- Vance Thompson Vision Surgery Center Prof LLC
- Julie K Vandam
- Janelle Vande Griend
- Sue Ann Vande Kamp
- Erin E Vande Lune
All providers in Sioux Falls, SD · Ophthalmology Physician in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.