Heather Marie Bergerud, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2621 Issued in MN

Practice address

3745 Louisiana Ave S
St. Louis Park, MN 55426

Phone

(952) 922-4427

Fax

(952) 922-4761

NPI assigned

Nov 15, 2006

Sex

Female

Sole proprietor

No

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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669545018",
    "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": {
        "last_name": "BERGERUD",
        "first_name": "HEATHER",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_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": []
}

• Lauren Berg
• Olivia Marie Berg
• Richard M Bergenstal, MD
• Barbara Ellen Berger, MSW
• Michael Erling Berger, PHD, L.P.
• Johanna Thea Bergh, DPT
• Kristen Berglie
• Jack William Bergman, PA-C
• Rogene L Tweeten Bergquist, MSSW
• Michelle Renee Bergren, P.T.

• 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.