Provider Demographics
NPI:1134656937
Name:DRS LIUDAHL & BLEEKER PC
Entity Type:Organization
Organization Name:DRS LIUDAHL & BLEEKER PC
Other - Org Name:MABEE EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-996-2537
Mailing Address - Street 1:305 N SANBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2449
Mailing Address - Country:US
Mailing Address - Phone:605-996-2537
Mailing Address - Fax:605-996-0500
Practice Address - Street 1:305 N SANBORN BLVD
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2449
Practice Address - Country:US
Practice Address - Phone:605-996-2537
Practice Address - Fax:605-996-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0208230001Medicare NSC