Provider Demographics
NPI:1225090459
Name:DRS. TUCKER-KUDRNA-HOLEC-YOUNG EYE CARE CENTRE LLP
Entity Type:Organization
Organization Name:DRS. TUCKER-KUDRNA-HOLEC-YOUNG EYE CARE CENTRE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLEC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-342-0777
Mailing Address - Street 1:2020 JACKSON BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3483
Mailing Address - Country:US
Mailing Address - Phone:605-342-0777
Mailing Address - Fax:605-342-7282
Practice Address - Street 1:2020 JACKSON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3483
Practice Address - Country:US
Practice Address - Phone:605-342-0777
Practice Address - Fax:605-342-7282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD459152W00000X
SD520152W00000X
SD587152W00000X
SD626152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD520OtherDR KUDRNA STATE LICENSE
SD626OtherDR. YOUNG STATE LICENSE
SD9201280Medicaid
SD9202543Medicaid
SD9203593Medicaid
SD9200363Medicaid
SD587OtherDR HOLEC STATE LICENSE
SD0040353OtherWELLMARK BCBS ID NUMBER
SD459OtherDR TUCKER STATE LICENSE
SDS40353OtherMEDICARE PTAN
SD9202543Medicaid
SD1300810001Medicare NSC
SDU51330Medicare UPIN
SD0040353OtherWELLMARK BCBS ID NUMBER
SD9200363Medicaid