DR. Nathan Henry Wiederholt, O.D.

NPI #1447414461 in Custer, South Dakota

Provider Information

NPI Number: 1447414461
Entity Type: Individual
Name: DR. Nathan Henry Wiederholt, O.D.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Optometrist
Credential: O.D.
Enumeration Date: Jul 18, 2008
Last Updated: Jun 16, 2010

Practice Location

Address: 322 MOUNT RUSHMORE RD
Address 2: SUITE 120
City: Custer
State: South Dakota
ZIP Code: 57730-1936
Phone: (605) 673-2716

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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Organizations

Provider Name	Specialty	City
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