Individual
FRED A LUNDQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
502 E. NEW HAVEN AVE., MELBOURNE, FL 32901-5427
(321) 727-2020
(321) 984-9547
Mailing address
502 E. NEW HAVEN AVE., MELBOURNE, FL 32901-5427
(321) 727-2020
(321) 984-9547
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC924
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19983
BLUE CROSS / BLUE SHIELD
FL
01
—
2885280
AETNA HMO
FL
01
—
410047717
RAILROAD MEDICARE
FL
01
—
4325330
AETNA PPO
FL
01
—
528645500
CIGNA
FL
05
—
620734100
—
FL
Enumeration date
05/12/2006
Last updated
11/15/2011
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