Individual
DR. HEATHER MARIE BERGERUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
3745 LOUISIANA AVE S, ST. LOUIS PARK, MN 55426
(952) 922-4427
(952) 922-4761
Mailing address
290 GREENLEAF CT., CHANHASSEN, MN 55317
(952) 403-1694
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2621
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2201839
MEDICA
MN
01
—
300J5BE
BCBS
MN
Enumeration date
11/15/2006
Last updated
07/08/2007
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