Larry J. Bonderud, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

393 Issued in MT

Legal business name

LARRY J. BONDERUD, OD

Doing business as

Northern Montana Eyecare

Practice address

865 Oilfield Ave Ste 1
Shelby, MT 59474-2702

Phone

(406) 434-5196

Fax

(406) 434-5197

NPI assigned

May 22, 2018

Last updated

Jun 16, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

LARRY J BONDERUD OD, DBA NORTHERN MONTANA EYECAREAs reported in NPPES

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

Authorized official

Name

Leann Appley

Title

Office Manager

Phone

(406) 434-5196

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Northern Montana Eyecare Doing business as

Tax ID family

Larry J Bonderud OD2 organizations share this tax ID, including this one

Part of

Larry J Bonderud OD

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Larry J. Bonderud, OD

  dba Northern Montana Eyecare

  • Optometrist
  • Conrad, MT
  • NPI 1952812331
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joren David Bonderud, OD

  • Optometrist
  • Shelby, MT
  • NPI 1679063853
  NPD (past)

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

{
    "created_epoch": "1526947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1497246722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 OILFIELD AVE STE 1",
            "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 STE 1",
            "city": "SHELBY",
            "state": "MT",
            "postal_code": "594742702",
            "telephone_number": "406-434-5196",
            "fax_number": "406-434-5197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY J. BONDERUD, OD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LARRY J BONDERUD OD, DBA NORTHERN MONTANA EYECARE",
        "enumeration_date": "2018-05-22",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "APPLEY",
        "authorized_official_first_name": "LEANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "406-434-5196"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MT",
            "license": "393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0481389",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Montana Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shelly Hunt, LCPC
• Gregory Trandon Lee Jefferson
• Charlene Yvette Johnson, COTA/L
• Alexander Kastner
• Robin Lynn Laine
• Rachael Lehr, APRN
• Logan Health - Shelby (Marias Medical Center)
• Logan Health - Shelby (Logan Health Clinic - Shelby)
• Logan Health Assisted Living - Shelby
• Logan Health Care Center - Shelby (Marias Care Center)

• 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 Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.