Provider Demographics
NPI:1174574800
Name:KNUDSEN, VICTORIA L (MD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:L
Last Name:KNUDSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1301 S CLIFF AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1023
Practice Address - Country:US
Practice Address - Phone:605-322-3790
Practice Address - Fax:605-322-3791
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78941207W00000X
SD8041207W00000X
UT6051574-1205207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A789410OtherBLUE SHIELD
SD6300730Medicaid
SDS104992Medicaid
F899OtherCHAMPUS
00A789410OtherBLUE SHIELD