Individual
DR. LARRY JAMES BONDERUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
865 OILFIELD AVE, SHELBY, MT 59474-2702
(406) 434-5196
(406) 434-5197
Mailing address
865 OILFIELD AVE, SHELBY, MT 59474-2702
(406) 434-5196
(406) 434-5197
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
393
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0481389
—
MT
01
—
25830
BC/BS PROVIDER #
MT
01
—
393
STATE TAX ID #
MT
01
—
410016078
RAILROAD PROVIDER #
MT
01
—
810378082001
EBMS PROVIDER #
MT
01
—
MSF0007633
MT STATE FUND PROVIDER #
MT
Enumeration date
08/15/2005
Last updated
05/26/2010
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