NPI 1164414322 · live from the CMS NPI Registry
Larry James Bonderud, O.D.
Optometrist in Shelby, MT. National Provider Identifier 1164414322, active.
NPI record
| NPI | 1164414322 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 865 Oilfield Ave, Shelby, MT 59474 |
| Practice phone | 406-434-5196 |
| Enumerated | August 15, 2005 |
| Last updated | May 26, 2010 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist primary | 152W00000X | 393 (MT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.