Active NPI
Glen A Gunderson, O.D.
- Corneal and Contact Management Optometrist
- Arvada, CO
National Provider Identifier
1295725554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Corneal and Contact Management Optometrist
- License
- OPT834
- Practice address
- 5801 Old Wadsworth Blvd
Arvada, CO 80003-5421 - Phone
- (303) 422-3817
- Fax
- (303) 423-6317
- NPI assigned
- Oct 26, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Corneal and Contact Management Optometrist | 152WC0802X | OPT834 | CO | Primary |
Addresses
Primary practice location
5801 Old Wadsworth Blvd
Arvada, CO 80003-5421
Mailing address
5801 Old Wadsworth Blvd
Arvada, CO 80003-5421
Phone (303) 422-3817
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT834 | CO | MD | Corneal and Contact Management Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277251200000",
"number": "1295725554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5801 OLD WADSWORTH BLVD",
"city": "ARVADA",
"state": "CO",
"postal_code": "800035421",
"telephone_number": "303-422-3817",
"fax_number": "303-423-6317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5801 OLD WADSWORTH BLVD",
"city": "ARVADA",
"state": "CO",
"postal_code": "800035421",
"telephone_number": "303-422-3817",
"fax_number": "303-423-6317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNDERSON",
"first_name": "GLEN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-26",
"last_updated": "2010-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "CO",
"license": "OPT834",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arvada, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.