Joren David Bonderud, OD
Individual provider Active NPI Optometrist · Shelby, MT
NPI 1679063853 · NPPES record last updated May 14, 2018
Key facts
- NPI
- 1679063853
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3153 (MT)
- Practice address
- 865 Oilfield Ave
Shelby, MT 59474-2702 - Phone
- (406) 434-5196
- Fax
- (406) 434-5197
- NPI assigned
- May 14, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3153 | MT | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Larry J. Bonderud, OD | Optometrist | Past |
Accepting new patients |
| Larry Bonderud & Mark Stanchfield Optometrists | Optometrist | Past |
Accepting new patients |
| Larry J. Bonderud, OD | Optometrist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3153 | MT | Yes |
Addresses
Primary practice location
865 Oilfield Ave
Shelby, MT 59474-2702
Mailing address
865 Oilfield Ave
Shelby, MT 59474-2702
Phone (406) 434-5196
Other practice location 1
19 4th Ave SW
Conrad, MT 59425-2339
Phone (406) 271-5517
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 May 14, 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.