Provider Demographics
NPI:1942271382
Name:BLEEKER, GREGG A (OD)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:A
Last Name:BLEEKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N SANBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2449
Mailing Address - Country:US
Mailing Address - Phone:605-996-2537
Mailing Address - Fax:605-996-0500
Practice Address - Street 1:305 N SANBORN BLVD
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2449
Practice Address - Country:US
Practice Address - Phone:605-996-2537
Practice Address - Fax:605-996-0500
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0076519OtherWELLMARK BCBS
SD141OtherDAKOTACARE
SD9201870Medicaid
SD9201872Medicaid
SD27992OtherSANFORD HEALTH PLAN
SD229999OtherMIDLANDS CHOICE
SD229999OtherMIDLANDS CHOICE
SD410017758Medicare PIN
SD9201872Medicaid
SD27992OtherSANFORD HEALTH PLAN
SDS76519Medicare PIN