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Individual

GREGORY ALLAN KOURI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
415 W 3RD ST, YANKTON, SD 57078-4201
(605) 665-9638
(605) 665-0526
Mailing address
PO BOX 819, YANKTON, SD 57078-0819
(605) 665-9638
(605) 665-0526

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
1065
NE
152W00000X
Optometrist
Primary
521
SD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0004557
SD WELLMARK BLUE SHIELD
SD
01
22055
NE BLUE SHIELD
NE
05
36-3050195-06
SD
05
36-3050195-07
NE
01
521
DAKOTACARE
05
9200084
SD
01
NA1114002
NE MEDICARE PTAN NORFOLK, NE
NE
Enumeration date
05/24/2005
Last updated
11/04/2008
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