Provider Demographics
NPI:1689754905
Name:OAKLAND, JEFFREY (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:OAKLAND
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 1:5012 S BUR OAK PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2228
Mailing Address - Country:US
Mailing Address - Phone:605-361-1680
Mailing Address - Fax:605-361-1590
Practice Address - Street 1:5012 S BUR OAK PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2228
Practice Address - Country:US
Practice Address - Phone:605-361-1680
Practice Address - Fax:605-361-1590
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1134188600Medicaid
SDS104929Medicare Oscar/Certification
SD1134188600Medicaid
SDT669Medicare PIN
SD0877020001Medicare NSC