Judson J Bergan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

126 Issued in SD

Practice address

411 SE 10TH St
Madison, SD 57042-0058

Phone

(605) 256-2020

Fax

(605) 256-3597

NPI assigned

Oct 17, 2005

Last updated

Oct 22, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Madison Vision Clinic

  • Optometrist
  • Madison, SD
  • NPI 1861531642
  Authorized official Same address or phone
• Madison Vision Clinic, Inc.

  • Optometrist
  • Madison, SD
  • NPI 1174894356
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350864000000",
    "number": "1710976378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 58",
            "city": "MADISON",
            "state": "SD",
            "postal_code": "570420058",
            "telephone_number": "605-256-2020",
            "fax_number": "605-256-3597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 SE 10TH ST",
            "city": "MADISON",
            "state": "SD",
            "postal_code": "570420058",
            "telephone_number": "605-256-2020",
            "fax_number": "605-256-3597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGAN",
        "first_name": "JUDSON",
        "middle_name": "J",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-17",
        "last_updated": "2012-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SD",
            "license": "126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9201230",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BLUE CROSS & BLUE SHIELD",
            "identifier": "0070102",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Reid James Allred, M.D.
• Avera Home Medical Equipment, LLC
• Jackie Joanne Bau, FNP-C
• Megan Bechen, PHARM.D.
• Mary W Beecher, M.D.
• Bethel Lutheran Home
• Paul Bindert
• Abigayle Rose Blanchette, PHARMD
• Michael Steven Brooke, OD
• Tonya D Buchholz, CNP

• Optometrist in Madison, SD
• Providers in Madison, SD by specialty
• Optometrist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.