Healthcare Provider Details

I. General information

NPI: 1730113887
Provider Name (Legal Business Name): RODNEY JEROME HESS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19022 FREEPORT AVE NW
ELK RIVER MN
55330-4767
US

IV. Provider business mailing address

19022 FREEPORT AVE NW SUITE H
ELK RIVER MN
55330-4767
US

V. Phone/Fax

Practice location:
  • Phone: 763-441-1055
  • Fax: 763-441-7024
Mailing address:
  • Phone: 763-441-1055
  • Fax: 763-441-7024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2535
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2535
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number2535
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number2535
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: