MEDICARE: CHRISTIAN DEJONGH

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	780	SD

General Provider Information

NPI Number	:	1538892112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN DEJONGH

Provider Business Mailing Address
First Line	:	PO BOX 324
Second Line	:
City	:	HOWARD
State	:	SD
Zip	:	57349-0324
Country	:	US
Telephone Number	:	712-470-5843
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 N HARTH AVE
Second Line	:
City	:	MADISON
State	:	SD
Zip	:	57042-2219
Country	:	US
Telephone Number	:	605-256-6911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2022
Last Update Date	:	07/01/2022

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Directions to “ CHRISTIAN DEJONGH ” Practice Location

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