# LANCE K BERGSTROM MD, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bergstrom Eye and Laser Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801819826
- **Authorized official:** DR. LANCE BERGSTROM M.D. (OWNER)
- **Authorized official phone:** (701) 235-5200

## Contact information

- **Practice address:** 2601 UNIVERSITY DR S, FARGO, ND 58103-6025
- **Practice address phone:** (701) 235-5200
- **Practice address fax:** (701) 237-0927
- **Mailing address:** 2601 UNIVERSITY DR S, FARGO, ND 58103-6025
- **Mailing address phone:** (701) 235-5200
- **Mailing address fax:** (701) 237-0927

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 2581 | MN | — |
| 152W00000X | Optometrist | 545 | ND | — |
| 174400000X | Specialist | 38105 | MN | — |
| 174400000X | Specialist | 7230 | ND | Yes |

## Other

- **Enumeration date:** 07/25/2006
- **Last updated:** 07/22/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01068001 | BLUE CROSS FEDERAL | ND |
| 05 | — | 12698 | — | ND |
| 01 | — | 33A70BE | COMPREHENSIVE CARE SERVIC | MN |