NPIMap

Organization Active NPI

Larry J. Bonderud, OD

Doing business as Northern Montana Eyecare

  • Optometrist
  • Conrad, MT
National Provider Identifier
1952812331
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
393 Issued in MT
Legal business name
LARRY J. BONDERUD, OD
Doing business as
Northern Montana Eyecare
Practice address
19 4TH Ave SW
Conrad, MT 59425-2339
Phone
(406) 271-5517
Fax
(406) 271-5518
NPI assigned
Oct 12, 2017
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Dr. Larry James Bonderud, ODNPI 1164414322
Title
Owner
Phone
(406) 434-5196

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 393 MT Primary

Addresses

Primary practice location

19 4TH Ave SW
Conrad, MT 59425-2339

Mailing address

865 Oilfield Ave
Shelby, MT 59474-2702
Phone (406) 434-5196

Other practice location 1

865 Oilfield Ave
Shelby, MT 59474-2702
Phone (406) 434-5196

Other identifiers 1

IdentifierTypeStateIssuer
00481389MedicaidMT

Other names 1

  • Northern Montana Eyecare Doing business as

National Provider Directory

National Provider Directory
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.

Locations

19 4th Ave SW
Conrad, MT 59425
Phone (406) 271-5517

865 Oilfield Ave
Shelby, MT 59474
Phone (406) 434-3142

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": "",
            "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"
        }
    ]
}

Other providers in Conrad, MT

Sources for this page

  • 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.