Basic Information
| Provider Information | |||||||||
| NPI: | 1558575498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHIRBER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 3RD ST | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577017374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053412000 | ||||||||
| FaxNumber: | 6057193211 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 3RD ST | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577017374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053412000 | ||||||||
| FaxNumber: | 6057193211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | LD2984000 | MN | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 645 | SD | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 4992665 | 01 | SD | WELLMARK | OTHER | 9203792 | 05 | SD | MEDICAID | 9253095 | 01 | SD | DAKOTACARE | OTHER | 4992666 | 01 | SD | WELLMARK | OTHER | 9203793 | 05 | SD | MEDICAID |