Dr. Glen D Nydam
Optometrist
305 N Sanborn Blvd
Mitchell
, South Dakota 57301-2449
Dr. Glen D Nydam
Optometrist
305 N Sanborn Blvd
Mitchell
, South Dakota 57301-2449
(605) 996-0500
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About
Features
Specialties
- Optometrist
Languages spoken
- English
Location
First Address
- Dr. Glen D Nydam
- 305 N Sanborn Blvd
- Mitchell, SD
- Zip : 57301-2449
- Fax : (605) 996-0500
- Phone : (605) 996-2537
Second Address
- Dr. Glen D Nydam
- 305 N Sanborn Blvd
- Mitchell, SD
- Zip : 57301-2449
- Fax : (605) 996-0500
- Phone : (605) 996-2537
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 542 | SD |
National Provider Identifier
| NPI | 1003887688 |
|---|---|
| Provider Name | Dr. Glen D Nydam |
| First Address | Mitchell, SD 57301-2449 |
| Second Address | Mitchell, SD 57301-2449 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 31/01/2006 |
| Last Update Date | 17/02/2010 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0006936 | WELLMARK BCBS (01) | SD |
| 20048 | SANFORD HEALTH PLAN (01) | SD |
| 230048 | MIDLANDS CHOICE (01) | SD |
| 9170527 | DAKOTACARE (01) | SD |
| 9203190 | (05) | SD |
| 9203192 | (05) | SD |
| U79671 | (02) | SD |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.