Bonderud, Larry James

Bonderud, Larry James is an sole proprietor health care provider with primary practice located at 865 Oilfield Ave , Shelby MT 59474-2702. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Bonderud, Larry James can be contacted via phone (406) 434-5196.

Contact Information

Primary practice address
865 Oilfield Ave Shelby MT 59474-2702
Phone: (406) 434-5196
Fax: (406) 434-5197
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 393 Montana

Profile Details

NPI number 1164414322
LBN Legal business name Bonderud, Larry James
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 15th, 2005
Last updated May 26th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164414322 NPPES
Montana Other 25830 BC/BS PROVIDER #
Montana Other 410016078 BC/BS PROVIDER #
Montana Other 393 BC/BS PROVIDER #
Montana Other MSF0007633 BC/BS PROVIDER #
Montana MEDICAID 0481389 BC/BS PROVIDER #
Montana Other 810378082001 BC/BS PROVIDER #

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