Larry J. Bonderud, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

393 Issued in MT

Legal business name

LARRY J. BONDERUD, OD

Practice address

19 4TH Ave SW
Conrad, MT 59425-2339

Phone

(406) 271-5517

Fax

(406) 271-5518

NPI assigned

Oct 12, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Larry James Bonderud, OD

Title

Owner

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

Other organizations with this tax ID 1

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

• Larry J. Bonderud, OD

  • Optometrist
  • Shelby, MT
  • NPI 1497246722
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joren David Bonderud, OD

  • Optometrist
  • Shelby, MT
  • NPI 1679063853
  NPD (past)
• Mark Stanchfield, O.D.

  • Optometrist
  • Cut Bank, MT
  • NPI 1235118258
  NPD (past)

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

{
    "created_epoch": "1507766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1952812331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 OILFIELD AVE",
            "city": "SHELBY",
            "state": "MT",
            "postal_code": "594742702",
            "telephone_number": "406-434-5196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 4TH AVE SW",
            "city": "CONRAD",
            "state": "MT",
            "postal_code": "594252339",
            "telephone_number": "406-271-5517",
            "fax_number": "406-271-5518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "865 Oilfield Ave",
            "address_purpose": "LOCATION",
            "city": "Shelby",
            "state": "MT",
            "postal_code": "594742702",
            "country_code": "US",
            "telephone_number": "406-434-5196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LARRY J. BONDERUD, OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-12",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "BONDERUD",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-434-5196",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MT",
            "license": "393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00481389",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Montana Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heather Johns, FNP
• Pamela K Johnson, L.C.P.C.
• Katie Lynn Jones, LCPC
• Stephanie Sue Keil, CCC-SLP
• Larry Bonderud & Mark Stanchfield Optometrists
• Edward Leas, PA
• Logan Health - Conrad
• Logan Health - Conrad
• Logan Health - Conrad
• Logan Health - Conrad

• All providers in Conrad, MT
• Optometrist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.