MEDICARE: DON J HERVE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2716	MN

General Provider Information

NPI Number	:	1215933213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DON J HERVE OD

Provider Business Mailing Address
First Line	:	4615 160TH LN NW
Second Line	:
City	:	ANDOVER
State	:	MN
Zip	:	55304-2213
Country	:	US
Telephone Number	:	763-434-4948
Fax Number	:

Provider Business Practice Location Address
First Line	:	23168 SAINT FRANCIS BLVD NW STE 600
Second Line	:
City	:	SAINT FRANCIS
State	:	MN
Zip	:	55070-8802
Country	:	US
Telephone Number	:	763-753-6019
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	02/13/2024

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