Individual
DANIEL JULIEN LUNDGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4601 DALE RD, MODESTO, CA 95356-9718
(209) 735-3150
(209) 735-3155
Mailing address
4601 DALE RD, MODESTO, CA 95356-9718
(209) 735-3150
(209) 735-3155
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9435T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410047220
RAILROAD MEDICARE
—
05
—
SD0094350
—
CA
Enumeration date
10/18/2005
Last updated
01/03/2022
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