Bruce Lundin, OD LLC
Individual provider Active NPI Optometrist · Sequim, WA
NPI 1750336152 · NPPES record last updated Jun 11, 2020
Key facts
- NPI
- 1750336152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 00003612 (WA)
- Practice address
- 955 W Washington St
Sequim, WA 98382-3266 - Phone
- (360) 406-2034
- NPI assigned
- May 23, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1221 S Hayford Rd
Spokane, WA 99224-7023
Phone (509) 459-0619
476999 Hwy 95
Ponderay, ID 83852-9738
Phone (360) 406-2034
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA, ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200804001165 | WA | Practitioner - Optometry | 2365485778 | Reassigns benefits to 1 organization |
| I20250123002607 | ID | Practitioner - Optometry | 2365485778 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 279166-9934 | UT | MD | Optometrist |
| 00003612 | WA | MD | Optometrist |
| 3612 | WA | MD | Optometrist |
| NV412 | NV | MD | Corneal and Contact Management Optometrist |
| 644 | ND | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fred E Clayson MD PC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 00003612 | WA | Yes |
| Corneal and Contact Management Optometrist | 152WC0802X | NV412 | NV | |
| Optometrist | 152W00000X | 279166-9934 | UT | |
| Optometrist | 152W00000X | 726 | NV | |
| Optometrist | 152W00000X | 3612 | WA |
Addresses
Primary practice location
955 W Washington St
Sequim, WA 98382-3266
Mailing address
955 W Washington St
Sequim, WA 98382-3266
Phone (360) 406-2034
Other practice location 1
356 E 2440 N
North Logan, UT 84341-1781
Phone (435) 232-2690
Other practice location 2
1550 N Main St
North Logan, UT 84341-1918
Phone (435) 753-3906
Other practice location 3
2944 Mountain City Hwy
Elko, NV 89801
Phone (435) 232-2690
Other practice location 4
2944 Mountain City Hwy
Elko, NV 89801
Phone (435) 232-2690
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000009105 | Other | UT | MEDICARE STORE #6 PTAN |
| 999000797009 | Medicaid | UT | |
| 000004473 | Other | UT | MEDICARE STORE #04 PTAN |
| 003116904 | Medicaid | NV | |
| 004716904 | Medicaid | NV |
Other providers in Sequim, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.