NPI 1679063853 · live from the CMS NPI Registry
Joren David Bonderud, OD
Optometrist in Shelby, MT. National Provider Identifier 1679063853, active.
NPI record
| NPI | 1679063853 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 865 Oilfield Ave, Shelby, MT 59474 |
| Practice phone | 406-434-5196 |
| Enumerated | May 14, 2018 |
| Last updated | May 14, 2018 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist primary | 152W00000X | 3153 (MT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.