Lance K Bergstrom MD, PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

7230 Issued in ND

Legal business name

LANCE K BERGSTROM MD, PC

Doing business as

Bergstrom Eye and Laser Clinic

Practice address

2601 University Dr S
Fargo, ND 58103-6025

Phone

(701) 235-5200

Fax

(701) 237-0927

NPI assigned

Jul 25, 2006

Last updated

Jul 22, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Lance Bergstrom, M.D.NPI 1578509733

Title

Owner

Phone

(701) 235-5200

Specialties & licenses 4

Addresses

Other identifiers 6

Other names 1

• Bergstrom Eye and Laser Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in ND, MN2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lance K Bergstrom, M.D.

  • Specialist
  • Fargo, ND
  • NPI 1578509733

  MN

  Medicare reassignment Care Compare group NPD Authorized official
• Emily J Heinrich, OD

  • Optometrist
  • Fargo, ND
  • NPI 1982591079
  Medicare reassignment Care Compare group NPD
• Tracie Malsom, OD

  • Optometrist
  • Fargo, ND
  • NPI 1720038441
  Medicare reassignment Care Compare group NPD
• Jennifer Ackerson, NP

  • Family Nurse Practitioner
  • Fargo, ND
  • NPI 1851117428
  Medicare reassignment NPD
• Matthew Stein, OD

  • Optometrist
  • Maple Grove, MN
  • NPI 1205501095

  ND

  Medicare reassignment NPD
• Cody Scott Ward

  • Optometrist
  • Tulsa, OK
  • NPI 1184364093

  ND

  Medicare reassignment NPD
• Becky Lee McIlonie Vandeberg, O.D.

  • Optometrist
  • Fargo, ND
  • NPI 1245430370
  NPD (past)
• Marc William Harrie, O.D.

  • Optometrist
  • Bloomington, MN
  • NPI 1427502749
  NPD (past)
• Larry Donavon Morrison, O.D.

  • Optometrist
  • Mahnomen, MN
  • NPI 1841298445
  NPD (past)
• Michael Anthony Morrison, O.D.

  • Optometrist
  • Mahnomen, MN
  • NPI 1164457750
  NPD (past)
• Steven B Thom, MD

  • Ophthalmology Physician
  • Fergus Falls, MN
  • NPI 1063434637
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279756800000",
    "number": "1801819826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036025",
            "telephone_number": "701-235-5200",
            "fax_number": "701-237-0927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036025",
            "telephone_number": "701-235-5200",
            "fax_number": "701-237-0927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANCE K BERGSTROM MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2010-07-22",
        "status": "A",
        "authorized_official_last_name": "BERGSTROM",
        "authorized_official_first_name": "LANCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-235-5200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "545",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2581",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "38105",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ND",
            "license": "7230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPREHENSIVE CARE SERVIC",
            "identifier": "33A70BE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS FEDERAL",
            "identifier": "01068001",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MN",
            "identifier": "33A70BE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12698",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUEPLUS OF MN",
            "identifier": "33A70BE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ND",
            "identifier": "01068001",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bergstrom Eye and Laser Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carey Lamoureaux
• Jennifer Lynn Lamp, P.T.
• Stuart Charles Lamp, D.C.
• Yu-Tung Lan, MD, MPH
• James H. Lancaster, DDS, MS
• Daniel Barrett Landauer, PHD
• Nicole Landen, CRNA
• Joshua Landis, LBSW
• Katelynn Landis
• Kaitlin Landowski, DC

• Specialist in Fargo, ND
• Providers in Fargo, ND by specialty
• Specialist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.