Organization
LARRY BONDERUD & MARK STANCHFIELD OPTOMETRISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY JAMES BONDERUD O.D. (OWNER)
(406) 434-5196
Entity
Organization
Contact information
Practice address
19 4TH AVE SW, CONRAD, MT 59425-2339
(406) 271-5517
(406) 271-5518
Mailing address
PO BOX 815, CONRAD, MT 59425-0815
(406) 271-5517
(406) 271-5518
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
393
MT
152W00000X
Optometrist
Primary
516
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0481491
—
MT
05
—
0482261
—
MT
Enumeration date
03/19/2007
Last updated
07/27/2010
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