Provider Demographics
NPI:1255391801
Name:OSMUNDSON, GREGORY D (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:OSMUNDSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6601 S MINNESOTA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2564
Mailing Address - Country:US
Mailing Address - Phone:605-336-6294
Mailing Address - Fax:605-336-0266
Practice Address - Street 1:6601 S MINNESOTA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-336-6294
Practice Address - Fax:605-336-0266
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD4573207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN123714OtherUCARE MN
MN137323400Medicaid
HP76197OtherHEALTHPARTNERS
NE46031185613OtherNE MEDICAID
IA0524207Medicaid
SD6301490Medicaid
MN663S4OSOtherMNBS NON
SD6238OtherSD WELLMARK
SD4573OtherDAKOTACARE
MN06F30OSOtherMN BLUE SHIELD
IA25529OtherWELLMARK OF IA
MN180000858Medicare PIN
SD4573OtherDAKOTACARE
MN123714OtherUCARE MN
SDS6328Medicare PIN
MN663S4OSOtherMNBS NON
HP76197OtherHEALTHPARTNERS
IA25529OtherWELLMARK OF IA
IA180041906Medicare PIN