Nydam, Glen D

Nydam, Glen D is an individual health care provider with primary practice located at 305 N Sanborn Blvd , Mitchell SD 57301-2449. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Nydam, Glen D can be contacted via phone (605) 996-2537.

Contact Information

Primary practice address
305 N Sanborn Blvd Mitchell SD 57301-2449
Phone: (605) 996-2537
Fax: (605) 996-0500
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 542 South Dakota

Profile Details

NPI number 1003887688
LBN Legal business name Nydam, Glen D
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 31st, 2006
Last updated Nov 10th, 2022 - about 2 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003887688 NPPES
South Dakota Other 20048 SANFORD HEALTH PLAN
South Dakota Other 9170527 SANFORD HEALTH PLAN
South Dakota MEDICAID 9203192 SANFORD HEALTH PLAN
South Dakota Other 0006936 SANFORD HEALTH PLAN
South Dakota Other 230048 SANFORD HEALTH PLAN
South Dakota MEDICAID 9203190 SANFORD HEALTH PLAN

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