Provider Demographics
NPI:1699723387
Name:HUPKE, JENNIFER A (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:HUPKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 S. MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:TEA
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2559
Mailing Address - Country:US
Mailing Address - Phone:605-274-6717
Mailing Address - Fax:605-275-4804
Practice Address - Street 1:6201 S. MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:TEA
Practice Address - State:SD
Practice Address - Zip Code:57108-2559
Practice Address - Country:US
Practice Address - Phone:605-274-6717
Practice Address - Fax:605-275-4804
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0593152W00000X
SD593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0040692OtherBLUE CROSS BLUE SHIELD
SD9201722Medicaid
SDSD0593OtherEYEMED
SD9201723Medicaid
SD30671OtherSIOUX VALLEY HEALTH PLAN
SD9201724Medicaid
SD9212280OtherDAKOTA CARE