Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 610 | SD |
NPI | 1285672246 |
---|---|
Provider Name | Dr. John Wesley Joseph Sivesind |
First Address | Sioux Falls, SD 57110-0400 |
Second Address | Sioux Falls, SD 57110-0400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9203460 | (05) | SD |
V06181 | (02) | SD |