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Individual

DR. RICK G LUNDGREN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
180 MICHIGAN AVE., OROFINO, ID 83544-9066
(208) 476-4814
(208) 476-3921
Mailing address
PO BOX 147, OROFINO, ID 83544-0147
(208) 476-4814
(208) 476-3921

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-729
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
002600100
ID
Enumeration date
09/21/2005
Last updated
06/29/2010
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