MEDICARE: DRS. TUCKER-KUDRNA-HOLEC-YOUNG EYE CARE CENTRE LLP

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
1	152W00000X	Optometrist	459	SD
2	152W00000X	Optometrist	520	SD
3	152W00000X	Optometrist	626	SD
4	152W00000X	Optometrist	587	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	S40353	OTHER	SD	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	520	OTHER	SD	DR KUDRNA STATE LICENSE
2	626	OTHER	SD	DR. YOUNG STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	587	OTHER	SD	DR HOLEC STATE LICENSE
8	0040353	OTHER	SD	WELLMARK BCBS ID NUMBER
9	459	OTHER	SD	DR TUCKER STATE LICENSE

General Provider Information

NPI Number	:	1225090459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. TUCKER-KUDRNA-HOLEC-YOUNG EYE CARE CENTRE LLP

Provider Business Mailing Address
First Line	:	2020 JACKSON BLVD STE 1
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3483
Country	:	US
Telephone Number	:	605-342-0777
Fax Number	:	605-342-7282

Provider Business Practice Location Address
First Line	:	2020 JACKSON BLVD STE 1
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3483
Country	:	US
Telephone Number	:	605-342-0777
Fax Number	:	605-342-7282

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. BILL J HOLEC
Credential	:	O.D.
Telephone Number	:	605-342-0777

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	06/20/2017

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