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:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 VIKINGS PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1187
Mailing Address - Country:US
Mailing Address - Phone:651-280-4420
Mailing Address - Fax:651-280-4155
Practice Address - Street 1:855 VIKINGS PKWY STE B
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1187
Practice Address - Country:US
Practice Address - Phone:651-280-4420
Practice Address - Fax:651-280-4155
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2489000152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C951HEOtherBLUE CROSS BLUE SHIELD
MNHP23908OtherHEALTH PARTNERS
MNXX1901014939OtherPREFERRED ONE
MN110177OtherUCARE
MN2200925OtherMEDICA
OD0001OtherAMERICAS PPO
MN948722100Medicaid
MN110177OtherUCARE