Active NPI
Daniel Julien Lundgren, OD
- Optometrist
- Modesto, CA
National Provider Identifier
1811986375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 9435T
- Practice address
- 4601 Dale Rd
Modesto, CA 95356-9718 - Phone
- (209) 735-3150
- Fax
- (209) 735-3155
- NPI assigned
- Oct 18, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 9435T | CA | Primary |
Addresses
Primary practice location
4601 Dale Rd
Modesto, CA 95356-9718
Mailing address
4601 Dale Rd
Modesto, CA 95356-9718
Phone (209) 735-3150
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410047220 | Other | RAILROAD MEDICARE | |
| SD0094350 | Medicaid | CA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) | The Permanente Medical Group |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9435T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641168000000",
"number": "1811986375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 DALE RD",
"city": "MODESTO",
"state": "CA",
"postal_code": "953569718",
"telephone_number": "209-735-3150",
"fax_number": "209-735-3155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4601 DALE RD",
"city": "MODESTO",
"state": "CA",
"postal_code": "953569718",
"telephone_number": "209-735-3150",
"fax_number": "209-735-3155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDGREN",
"first_name": "DANIEL",
"middle_name": "JULIEN",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-18",
"last_updated": "2022-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "9435T",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410047220",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0094350",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
"affiliation": "Y",
"endpointDescription": "Carequality",
"affiliationName": "The Permanente Medical Group",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "4601 Dale Rd",
"city": "Modesto",
"state": "CA",
"country_code": "US",
"postal_code": "953569718",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.