Individual provider Active NPI

Kurt Allen Lundquist, O.D.

  • Optometrist
  • Menifee, CA
National Provider Identifier
1447225297
Registry record updated Feb 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9751T Issued in CA
Practice address
30107 Haun Rd
Menifee, CA 92584-6825
Phone
(951) 434-6291
Fax
(951) 672-2137
NPI assigned
Feb 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9751T CA Primary

Addresses

Primary practice location

30107 Haun Rd
Menifee, CA 92584-6825

Mailing address

34746 Bitter Root CT
Murrieta, CA 92563-3397
Phone (951) 599-0866

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20120216000451 CA Practitioner - Optometry 2860650124 Practice locations: Menifee, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9751TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Adam Rosa OD Inc Optometrist PastSince Feb 24, 2022 Accepting new patients
National Vision, Inc. Past Accepting new patients
North Coast Optometry Optometrist Past Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487462400000",
    "number": "1447225297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34746 BITTER ROOT CT",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925633397",
            "telephone_number": "951-599-0866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30107 HAUN RD",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925846825",
            "telephone_number": "951-434-6291",
            "fax_number": "951-672-2137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUNDQUIST",
        "first_name": "KURT",
        "middle_name": "ALLEN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2017-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9751T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menifee, CA

Sources for this page

Verify at the official NPI Registry.