Healthcare Provider Details

I. General information

NPI: 1316881980
Provider Name (Legal Business Name): ANTHONY RAY HAGERTY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 FLYING CLOUD DR STE 2028
EDEN PRAIRIE MN
55344-5313
US

IV. Provider business mailing address

15441 YAKIMA CT NW
RAMSEY MN
55303-4251
US

V. Phone/Fax

Practice location:
  • Phone: 952-944-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4054
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: