Provider Demographics
NPI:1215933213
Name:HERVE, DON J (OD)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:J
Last Name:HERVE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:4615 160TH LN NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-2213
Mailing Address - Country:US
Mailing Address - Phone:763-434-4948
Mailing Address - Fax:
Practice Address - Street 1:23168 SAINT FRANCIS BLVD NW STE 600
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070-8802
Practice Address - Country:US
Practice Address - Phone:763-753-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2716152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU11200Medicare UPIN