Larry J. Bonderud, OD
Organization Active NPI Optometrist · Shelby, MT
NPI 1497246722 · NPPES record last updated Jun 16, 2018
Key facts
- NPI
- 1497246722
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 393 (MT)
- Legal business name
- LARRY J. BONDERUD, OD
- Practice address
- 865 Oilfield Ave Ste 1
Shelby, MT 59474-2702 - Phone
- (406) 434-5196
- Fax
- (406) 434-5197
- NPI assigned
- May 22, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- LARRY J BONDERUD OD, DBA NORTHERN MONTANA EYECARE
Authorized official
- Name
- Leann Appley
- Title
- Office Manager
- Phone
- (406) 434-5196
Corporate family (same tax ID) 1
Practitioners 1
National Provider Directory
- Tax ID family
- Larry J Bonderud OD
- Part of
- Larry J Bonderud OD
Locations
865 Oilfield Ave
Ste 1
Shelby, MT 59474
Phone (406) 434-5196
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 393 | MT | Yes |
Addresses
Primary practice location
865 Oilfield Ave Ste 1
Shelby, MT 59474-2702
Mailing address
865 Oilfield Ave Ste 1
Shelby, MT 59474-2702
Phone (406) 434-5196
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0481389 | Medicaid | MT |
Other names
- Northern Montana Eyecare
Other providers in Shelby, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2018. 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.