Organization
LANCE K BERGSTROM MD, PC
Active
Other names
Bergstrom Eye and Laser Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANCE BERGSTROM M.D. (OWNER)
(701) 235-5200
Entity
Organization
Contact information
Practice address
2601 UNIVERSITY DR S, FARGO, ND 58103-6025
(701) 235-5200
(701) 237-0927
Mailing address
2601 UNIVERSITY DR S, FARGO, ND 58103-6025
(701) 235-5200
(701) 237-0927
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2581
MN
152W00000X
Optometrist
545
ND
174400000X
Specialist
38105
MN
174400000X
Specialist
Primary
7230
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01068001
BLUE CROSS OF ND
ND
05
—
12698
—
ND
01
—
33A70BE
COMPREHENSIVE CARE SERVIC
MN
Enumeration date
07/25/2006
Last updated
07/22/2010
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