Individual
MARK R WINCKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
207 E MAIN ST STE 1, PINE RIDGE, SD 57770-3184
(605) 867-2772
Mailing address
PO BOX 399, PINE RIDGE, SD 57770-0399
(605) 867-2772
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1269
NE
152W00000X
Optometrist
631
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09902
BCBS OF NE
NE
01
—
4993077
WELLMARK BCBS
SD
05
—
9203680
—
SD
05
—
9203682
—
SD
05
—
9203683
—
SD
01
—
P00390774
RR MEDICARE
NE
Enumeration date
09/21/2006
Last updated
01/03/2024
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