Provider Demographics
NPI:1851369763
Name:GREAT PLAINS EYE CLINIC LTD
Entity Type:Organization
Organization Name:GREAT PLAINS EYE CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CLEMENT
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-334-7715
Mailing Address - Street 1:1701 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1751
Mailing Address - Country:US
Mailing Address - Phone:605-334-7715
Mailing Address - Fax:605-334-8247
Practice Address - Street 1:1701 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1751
Practice Address - Country:US
Practice Address - Phone:605-334-7715
Practice Address - Fax:605-334-8247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2075207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0007123OtherBLUE CROSS/SHIELD
SD301784OtherAVERA
SD7123OtherGEHA
SD25443OtherSIOUX VALLEY HEALTH PLAN
SD01014670OtherUNITED HEALTH CARE
MN90258WHOtherBLUE CROSS/SHIELD
SD6300190Medicaid
SC0007123OtherWELLMARK ADMINISTRATORS
SD6300190OtherDAKOTACARE
SD6300190OtherDAKOTACARE
MN90258WHOtherBLUE CROSS/SHIELD
SD6300190Medicaid