Larry Bonderud & Mark Stanchfield Optometrists
Organization Active NPI Optometrist · Conrad, MT
NPI 1295850535 · NPPES record last updated Jul 27, 2010
Key facts
- NPI
- 1295850535
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 516 (MT)
- Legal business name
- LARRY BONDERUD & MARK STANCHFIELD OPTOMETRISTS
- Practice address
- 19 4TH Ave SW
Conrad, MT 59425-2339 - Phone
- (406) 271-5517
- Fax
- (406) 271-5518
- NPI assigned
- Mar 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Larry James Bonderud, O.D.
- Title
- Owner
- Phone
- (406) 434-5196
Practitioners 2
-
Larry James Bonderud, O.D.
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 393 | MT | |
| Optometrist |
152W00000X | 516 | MT | Yes |
Addresses
Primary practice location
19 4TH Ave SW
Conrad, MT 59425-2339
Mailing address
PO Box 815
Conrad, MT 59425-0815
Phone (406) 271-5517
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0482261 | Medicaid | MT | |
| 0481491 | Medicaid | MT |
Other providers in Conrad, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.