Provider Demographics
NPI:1952309502
Name:FERGUSON, STEVEN J (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:FERGUSON
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 1:305 DAKOTA DUNES BLVD
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5176
Mailing Address - Country:US
Mailing Address - Phone:605-232-6900
Mailing Address - Fax:605-232-7007
Practice Address - Street 1:305 DAKOTA DUNES BLVD
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5176
Practice Address - Country:US
Practice Address - Phone:605-232-6900
Practice Address - Fax:605-232-7007
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0040851OtherWELLMARK BLUE CROSS BLUE SHIELD
SD9202154Medicaid
IA2538652Medicaid
NE82057327500Medicaid
NE82057327500Medicaid
SD0040851OtherWELLMARK BLUE CROSS BLUE SHIELD