Provider Demographics
NPI:1962835017
Name:GENTRUP, ASHLEY M (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:M
Last Name:GENTRUP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 S. MINNESOTE 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 1:106 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6417
Practice Address - Country:US
Practice Address - Phone:605-274-6717
Practice Address - Fax:605-275-4804
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1941DT152W00000X, 152WV0400X
SD712152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9204450Medicaid
SD9204452Medicaid