Provider Demographics
NPI:1043361843
Name:HEDQUIST, CHRISTOPHER A (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:HEDQUIST
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1601
Mailing Address - Country:US
Mailing Address - Phone:712-224-3937
Mailing Address - Fax:
Practice Address - Street 1:523 4TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1601
Practice Address - Country:US
Practice Address - Phone:712-224-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD618152W00000X
NE1210152W00000X
NE386152WV0400X
IA02254152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00120449OtherRAILROAD MCR
IA36349OtherBCBS
IA36349OtherBCBS
IAI10859Medicare ID - Type Unspecified431 PIERCE
U97918Medicare UPIN