Individual
BRUCE LUNDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD LLC
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
00003612
WA
152W00000X
Optometrist
279166-9934
UT
152W00000X
Optometrist
3612
WA
152W00000X
Optometrist
726
NV
152WC0802X
Corneal and Contact Management Optometrist
NV412
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000004473
MEDICARE STORE #04 PTAN
UT
01
—
000009105
MEDICARE STORE #6 PTAN
UT
05
—
003116904
—
NV
05
—
004716904
—
NV
05
—
999000797009
—
UT
Enumeration date
05/23/2006
Last updated
06/11/2020
Update your record
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