Individual
JUDSON J BERGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
411 SE 10TH ST, MADISON, SD 57042-0058
(605) 256-2020
(605) 256-3597
Mailing address
PO BOX 58, MADISON, SD 57042-0058
(605) 256-2020
(605) 256-3597
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
126
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0070102
WELLMARK BLUE CROSS & BLUE SHIELD
SD
05
—
9201230
—
SD
Enumeration date
10/17/2005
Last updated
10/22/2012
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