Individual
DR. COURTNEY RAY SIVERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3632 10TH LN NW, ROCHESTER, MN 55901-7032
(507) 282-7121
Mailing address
3632 10TH LN NW, ROCHESTER, MN 55901-7032
(507) 210-4894
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3070
MN
152W00000X
Optometrist
6246453-9934
UT
152WC0802X
Corneal and Contact Management Optometrist
3070
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09Y96LI
BLUE CROSS BLUE SHIELD
MN
01
—
09Y98SI
BLUE CROSS BLUE SHIELD
MN
01
—
09Y99LI
BLUE CROSS BLUE SHIELD
MN
01
—
138801
UCARE
MN
01
—
39797WE
BLUE CROSS BLUE SHIELD
MN
01
—
411898525
HUMANA
MN
01
—
617A1SI
BLUE CROSS BLUE SHIELD
MN
01
—
628A8SI
BLUE CROSS BLUE SHIELD
MN
01
—
6C464AN
BLUE CROSS BLUE SHIELD
MN
05
—
763132000
—
MN
01
—
916891050630
PREFERRED ONE
MN
01
—
HP77005
HEALTH PARTNERS
MN
Enumeration date
07/21/2006
Last updated
07/19/2012
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