Heather M Bergerud OD Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

2621 Issued in MN

Legal business name

HEATHER M BERGERUD OD INC

Practice address

3745 Louisiana Ave S
St. Louis Park, MN 55426

Phone

(952) 922-4427

Fax

(952) 922-4761

NPI assigned

Nov 15, 2006

Organization subpart

No

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

Authorized official

Name

Heather Marie Bergerud, OD

Title

Chief Officer

Phone

(952) 403-1694

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Heather M Bergerud OD Other name

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497828842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 GREENLEAF CT.",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "55317",
            "telephone_number": "952-403-1694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3745 LOUISIANA AVE S",
            "city": "ST. LOUIS PARK",
            "state": "MN",
            "postal_code": "55426",
            "telephone_number": "952-922-4427",
            "fax_number": "952-922-4761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEATHER M BERGERUD OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BERGERUD",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CHIEF OFFICER",
        "authorized_official_telephone_number": "952-403-1694",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2201839",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "300J5BE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heather M Bergerud OD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Keith M Heaton, M.D.
• Michael B Hebert, M.D.
• Devin Hedlund, MD
• Brittney L Hegg, RDN
• Melissa Ann Hegland-Smith, MA

• Optometrist in St. Louis Park, MN
• Providers in St. Louis Park, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.