Bergstrom Eye And Laser Clinic is a medicare enrolled "Specialist" provider in Fargo, North Dakota. Their current practice location is
2601 University Dr S, Fargo, North Dakota. You can reach out to their office (for appointments etc.) via phone at
(701) 235-5200.
Bergstrom Eye And Laser Clinic is licensed to practice in North Dakota (license number 7230) and it also participates in the medicare program. Bergstrom Eye And Laser Clinic
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1801819826.
Healthcare Provider's Profile
| Full Name | Bergstrom Eye And Laser Clinic |
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| Type | Facility |
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| Speciality | Specialist |
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| Location | 2601 University Dr S, Fargo, North Dakota |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1801819826
- Provider Enumeration Date: 07/25/2006
- Last Update Date: 07/22/2010
Medicare PECOS Information:
- PECOS PAC ID: 3577542216
- Enrollment ID: O20040716000370
Medical Identifiers
Medical identifiers for Bergstrom Eye And Laser Clinic such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1801819826 | NPI | - | NPPES |
| 01068001 | Other | ND | BLUE CROSS OF ND |
| 33A70BE | Other | MN | COMPREHENSIVE CARE SERVIC |
| 33A70BE | Other | MN | BLUEPLUS OF MN |
| 12698 | Medicaid | ND | |
| 33A70BE | Other | MN | BLUE CROSS OF MN |
| 01068001 | Other | ND | BLUE CROSS FEDERAL |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | 545 (North Dakota) | Secondary |
| 152W00000X | Optometrist | 2581 (Minnesota) | Secondary |
| 174400000X | Specialist | 7230 (North Dakota) | Primary |
| 174400000X | Specialist | 38105 (Minnesota) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Bergstrom Eye And Laser Clinic acts as a billing entity for following providers:
| Provider Name | Lance K Bergstrom |
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| Provider Type | Practitioner - Ophthalmology |
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| Provider Identifiers | NPI Number: 1578509733
PECOS PAC ID: 5092794735
Enrollment ID: I20100825000247 |
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| Provider Name | Tracie Malsom |
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| Provider Type | Practitioner - Optometry |
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| Provider Identifiers | NPI Number: 1720038441
PECOS PAC ID: 8628085750
Enrollment ID: I20131126001931 |
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| Provider Name | Matthew Stein |
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| Provider Type | Practitioner - Optometry |
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| Provider Identifiers | NPI Number: 1205501095
PECOS PAC ID: 6507261708
Enrollment ID: I20210826001498 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Bergstrom Eye And Laser Clinic is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Bergstrom Eye And Laser Clinic
2601 University Dr S,
Fargo, ND 58103-6025
Ph: (701) 235-5200 | Bergstrom Eye And Laser Clinic
2601 University Dr S,
Fargo, ND 58103-6025
Ph: (701) 235-5200 |
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