Bergan, Judson J
Bergan, Judson J is an sole proprietor health care provider with primary practice located at 411 Se 10Th St , Madison SD 57042-0058. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Bergan, Judson J can be contacted via phone (605) 256-2020.Contact Information
Primary practice address
411 Se 10Th St
Madison SD 57042-0058
Phone: (605) 256-2020
Fax: (605) 256-3597
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 126 | South Dakota |
Profile Details
| NPI number | 1710976378 |
|---|---|
| LBN Legal business name | Bergan, Judson J |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 17th, 2005 |
| Last updated | Oct 22nd, 2012 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710976378 | NPPES |
| South Dakota | MEDICAID | 9201230 | |
| South Dakota | Other | 0070102 |
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