| Premier Family Eye Care, Pc | |
|
322 Mount Rushmore Rd, Suite 120, Custer, SD 57730-1936 | |
| (605) 673-2716 | |
| (605) 673-2017 |
| Full Name | Premier Family Eye Care, Pc |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 322 Mount Rushmore Rd, Custer, South Dakota |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699919852 | NPI | - | NPPES |
| 9203883 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 656 (South Dakota) | Primary |
| Provider Name | Nathan H Wiederholt |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1447414461 PECOS PAC ID: 4688740665 Enrollment ID: I20080828000233 |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Family Eye Care, Pc 322 Mount Rushmore Rd, Suite 120, Custer, SD 57730-1936 Ph: (605) 673-2716 | Premier Family Eye Care, Pc 322 Mount Rushmore Rd, Suite 120, Custer, SD 57730-1936 Ph: (605) 673-2716 |
Vernon Wong, OD Optometrist Medicare: Not Enrolled in Medicare Practice Location: 25229 Pinto Ln, Custer, SD 57730 Phone: 605-673-5663 | |
Dr. Nathan Henry Wiederholt, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 322 Mount Rushmore Rd, Suite 120, Custer, SD 57730 Phone: 605-673-2716 Fax: 605-673-2017 |