Provider Demographics
NPI:1033505235
Name:HEDQUIST EYE CARE, LLC
Entity Type:Organization
Organization Name:HEDQUIST EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-224-3937
Mailing Address - Street 1:523 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1601
Mailing Address - Country:US
Mailing Address - Phone:712-224-3937
Mailing Address - Fax:
Practice Address - Street 1:523 4TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1601
Practice Address - Country:US
Practice Address - Phone:712-224-3937
Practice Address - Fax:712-224-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2254152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty