Lundgren, Rick G

Lundgren, Rick G is an individual health care provider with primary practice located at 180 Michigan Ave. , Orofino ID 83544-9066. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Lundgren, Rick G can be contacted via phone (208) 476-4814.

Contact Information

Primary practice address
180 Michigan Ave. Orofino ID 83544-9066
Fax: (208) 476-3921
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X ODP-729 Idaho

Profile Details

NPI number 1649266040
LBN Legal business name Lundgren, Rick G
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2005
Last updated Jun 29th, 2010 - about 15 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 1649266040 NPPES
Idaho MEDICAID 002600100

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