Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 2489000 | MN |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2489000 | MN |
N | 152WP0200X | Pediatric Optomitrist | 2489000 | MN |
N | 152WS0006X | Sports Vision | 2489000 | MN |
N | 152WX0102X | Occupational Vision | 2489000 | MN |
NPI | 1275622482 |
---|---|
Provider Name | Robert Wilbert Hegerman JR. |
First Address | Eagan, MN 55123-2324 |
Second Address | Eagan, MN 55123-2324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110177 | UCARE (01) | MN |
2200925 | MEDICA (01) | MN |
3C951HE | BLUE CROSS BLUE SHIELD (01) | MN |
HP23908 | HEALTH PARTNERS (01) | MN |
MH1108770 | DEA (01) | |
OD0001 | AMERICAS PPO (01) | |
U51390 | (02) | |
XX1901014939 | PREFERRED ONE (01) | MN |