Provider Demographics
NPI:1730113887
Name:HESS, RODNEY JEROME (OD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:JEROME
Last Name:HESS
Suffix:
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 1:19022 FREEPORT AVE NW
Mailing Address - Street 2:SUITE H
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-4767
Mailing Address - Country:US
Mailing Address - Phone:763-441-1055
Mailing Address - Fax:763-441-7024
Practice Address - Street 1:19022 FREEPORT AVE NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-4767
Practice Address - Country:US
Practice Address - Phone:763-441-1055
Practice Address - Fax:763-441-7024
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2535152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22-01028OtherMEDICA
MN410047336OtherRAILROAD MEDICARE
MN858814700Medicaid
MN1009722OtherPREFERRED ONE
MN115817OtherUCARE
MN4C529HEOtherBLUE CROSS BLUE SHIELD
MNHP18116OtherHEALTH PARTNERS
MN115817OtherUCARE