1962557066 NPI number — DR. PAUL HORNER O.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962557066 NPI number — DR. PAUL HORNER O.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HORNER

Provider First Name:

PAUL

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

O.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1962557066

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/22/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

613 N OAK RIDGE RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BRANDON

Provider Business Mailing Address State Name:

SD

Provider Business Mailing Address Postal Code:

57005-1573

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

605-582-3737

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

105 N SPLITROCK BLVD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BRANDON

Provider Business Practice Location Address State Name:

SD

Provider Business Practice Location Address Postal Code:

57005-1529

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

605-582-2990

Provider Business Practice Location Address Fax Number:

605-582-2991

Provider Enumeration Date:

01/25/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  535 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 4998511 . This is a "BCBS BRANDON" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 5C470HO . This is a "BCBS BRANDON" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 9201702 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 410031181 . This is a "RAILROAD MCR" identifier . This identifiers is of the category "OTHER".
• Identifier: 242530 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 5C469HO . This is a "BCBS SIOUX FALLS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 9202869-535.1 . This is a "DAKOTA CARE SIOUX FALLS" identifier . This identifiers is of the category "OTHER".
• Identifier: 20722 . This is a "SIOUX VALLEY HLTH PLN" identifier . This identifiers is of the category "OTHER".
• Identifier: 2202147 . This is a "MEDICA BRANDON" identifier . This identifiers is of the category "OTHER".
• Identifier: 9201700 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 0004506 . This is a "BCBS SIOUX FALLS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 2202146 . This is a "MEDICA SIOUX FALLS" identifier . This identifiers is of the category "OTHER".