Provider Demographics
NPI:1144219213
Name:CONROY, JOHN ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLEN
Last Name:CONROY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-2424
Mailing Address - Country:US
Mailing Address - Phone:605-432-5730
Mailing Address - Fax:605-432-4324
Practice Address - Street 1:411 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-2424
Practice Address - Country:US
Practice Address - Phone:605-432-5730
Practice Address - Fax:605-432-4324
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD491152W00000X
MN2118152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN358723100Medicaid
MN4645120001OtherDMERC
SD4645120002OtherDMERC
SD9202533Medicaid
SD9202533Medicaid
MN4645120001OtherDMERC
SD4645120002OtherDMERC