Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | SD3450 | SD |
NPI | 1033166459 |
---|---|
Provider Name | Scott Eccarius |
First Address | Rapid City, SD 57701-4678 |
Second Address | Rapid City, SD 57701-4678 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 06/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6300422 | (05) | SD |
E87040 | (02) | SD |
S2468 | MEDICARE PTAN (01) |