Bruce Lundin OD LLC
Organization Active NPI Optometrist · North Logan, UT
NPI 1942746342 · NPPES record last updated Jan 10, 2017
Key facts
- NPI
- 1942746342
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 279166-9934 (UT)
- Legal business name
- BRUCE LUNDIN OD LLC
- Practice address
- 1550 N Main St
North Logan, UT 84341-1918 - Phone
- (435) 753-3906
- NPI assigned
- Jan 10, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Bruce L Lundin, OD
- Title
- Optometrist
- Phone
- (435) 753-3906
Practitioners 1
-
Bruce Lundin, OD LLC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA, ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211130001965 | WA | Part B Supplier - Clinic/Group Practice | 9931432499 |
Receives reassigned benefits from 1 practitioner Practice locations: Spokane, WA; Spokane Valley, WA |
| O20250123002512 | ID | Part B Supplier - Clinic/Group Practice | 9931432499 |
Receives reassigned benefits from 1 practitioner Practice locations: Ponderay, ID |
National Provider Directory
Locations
476999 Highway 95
Ponderay, ID 83852
Phone (208) 255-5513
2944 Mountain City Hwy
Elko, NV 89801
Phone (775) 738-8212
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 279166-9934 | UT | Yes |
Addresses
Primary practice location
1550 N Main St
North Logan, UT 84341-1918
Mailing address
1550 N Main St
North Logan, UT 84341-1918
Phone (435) 753-3906
Other providers in North Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2017. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.