Individual
DR. GLEN D NYDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
305 N SANBORN BLVD, MITCHELL, SD 57301-2449
(605) 996-2537
(605) 996-0500
Mailing address
305 N SANBORN BLVD, MITCHELL, SD 57301-2449
(605) 996-2537
(605) 996-0500
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
542
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006936
WELLMARK BCBS
SD
01
—
20048
SANFORD HEALTH PLAN
SD
01
—
230048
MIDLANDS CHOICE
SD
01
—
9170527
DAKOTACARE
SD
05
—
9203190
—
SD
05
—
9203192
—
SD
Enumeration date
01/31/2006
Last updated
11/10/2022
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