Provider Demographics
NPI:1275622482
Name:HEGERMAN, ROBERT WILBERT JR (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILBERT
Last Name:HEGERMAN
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 DUCKWOOD DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2324
Mailing Address - Country:US
Mailing Address - Phone:651-452-0344
Mailing Address - Fax:651-452-1564
Practice Address - Street 1:1340 DUCKWOOD DR
Practice Address - Street 2:SUITE 14
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2324
Practice Address - Country:US
Practice Address - Phone:651-452-0344
Practice Address - Fax:651-452-1564
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2489000152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C951HEOtherBLUE CROSS BLUE SHIELD
MN110177OtherUCARE
MNHP23908OtherHEALTH PARTNERS
OD0001OtherAMERICAS PPO
MNXX1901014939OtherPREFERRED ONE
MN2200925OtherMEDICA
MN2200925OtherMEDICA
MN110177OtherUCARE