Basic Information
| Provider Information | |||||||||
| NPI: | 1174574800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNUDSEN | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MORRISON | ||||||||
| OtherFirstName: | VICTORIA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 S CLIFF AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053223790 | ||||||||
| FaxNumber: | 6053223791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 02/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | A78941 | CA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 8041 | SD | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 6051574-1205 | UT | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0107X | 6051574-1205 | UT | Y |
ID Information
| ID | Type | State | Issuer | Description | 00A789410 | 01 | BLUE SHIELD | OTHER | 6300730 | 05 | SD | MEDICAID | S104992 | 05 | SD | MEDICAID | F899 | 01 | CHAMPUS | OTHER |