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NPI Code Detail

MEDICARE: DR. GAYLENE R. KUDRNA OD

MEDICARE: DR. GAYLENE R. KUDRNA OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist520SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063570349
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GAYLENE R. KUDRNA OD
Provider Business Mailing Address
First Line : 2020 JACKSON BLVD
Second Line : SUITE 1
City : RAPID CITY
State : SD
Zip : 57702-3484
Country : US
Telephone Number : 605-342-0777
Fax Number : 605-342-7282
Provider Business Practice Location Address
First Line : 2020 JACKSON BLVD
Second Line : SUITE 1
City : RAPID CITY
State : SD
Zip : 57702-3484
Country : US
Telephone Number : 605-342-0777
Fax Number : 605-342-7282
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 11/02/2015

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