Provider Demographics
NPI:1235309162
Name:ANGELA R. GULBRANSON, OD, PC
Entity Type:Organization
Organization Name:ANGELA R. GULBRANSON, OD, PC
Other - Org Name:VISIONS EYE CARE & THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:PULFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-274-6717
Mailing Address - Street 1:6201 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2559
Mailing Address - Country:US
Mailing Address - Phone:605-274-6717
Mailing Address - Fax:605-275-4804
Practice Address - Street 1:6201 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2559
Practice Address - Country:US
Practice Address - Phone:605-274-6717
Practice Address - Fax:605-275-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9203263Medicaid
SDU84269Medicare UPIN
SD9203263Medicaid