Larry James Bonderud, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

393 Issued in MT

Practice address

865 Oilfield Ave
Shelby, MT 59474-2702

Phone

(406) 434-5196

Fax

(406) 434-5197

NPI assigned

Aug 15, 2005

Last updated

May 26, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern California College of Optometry, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Larry Bonderud & Mark Stanchfield Optometrists

  • Optometrist
  • Conrad, MT
  • NPI 1295850535
  NPD (past) Authorized official
• Larry J. Bonderud, OD

  dba Northern Montana Eyecare

  • Optometrist
  • Conrad, MT
  • NPI 1952812331
  Authorized official Same address or phone
• Sunrise Counseling

  • Mental Health Counselor
  • Conrad, MT
  • NPI 1790084523
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274832000000",
    "number": "1164414322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 OILFIELD AVE",
            "city": "SHELBY",
            "state": "MT",
            "postal_code": "594742702",
            "telephone_number": "406-434-5196",
            "fax_number": "406-434-5197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 OILFIELD AVE",
            "city": "SHELBY",
            "state": "MT",
            "postal_code": "594742702",
            "telephone_number": "406-434-5196",
            "fax_number": "406-434-5197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONDERUD",
        "first_name": "LARRY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2010-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MT",
            "license": "393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER #",
            "identifier": "25830",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0481389",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE TAX ID #",
            "identifier": "393",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PROVIDER #",
            "identifier": "410016078",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EBMS PROVIDER #",
            "identifier": "810378082001",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MT STATE FUND PROVIDER #",
            "identifier": "MSF0007633",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bret Frank Argenbright, OD
• Molly C Asper
• Adriana F Baker
• George Angelo Biancarelli, MD
• Joren David Bonderud, OD
• Alan W Bridge, DC
• Cary Randall Bybee, MD
• Ann M Clark
• Robert A Clary, D.O. P C
• Paije E Gianarelli

• Optometrist in Shelby, MT
• Providers in Shelby, MT by specialty
• Optometrist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.