Provider Demographics
NPI:1821065335
Name:YUNKER, JEFFERY (OD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:YUNKER
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 1:2900 S COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6070
Mailing Address - Country:US
Mailing Address - Phone:701-746-6745
Mailing Address - Fax:701-746-6961
Practice Address - Street 1:2900 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6070
Practice Address - Country:US
Practice Address - Phone:701-746-6745
Practice Address - Fax:701-746-6961
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND23567OtherBC/BS ND
NDDB2399OtherRAILROAD RETIREMENT
ND892828OtherND VISION SERVICES
ND342R7LIOtherBC/BS OF MN
ND5455550001OtherDMERC
ND342R7LIOtherBC/BS OF MN
NDU10357Medicare UPIN