Lundgren, Gary J
Lundgren, Gary J is an individual health care provider with primary practice located at 1110 Prairie St , Prairie Du Sac WI 53578-2044. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Lundgren, Gary J can be contacted via phone (608) 643-3333.Contact Information
Primary practice address
1110 Prairie St
Prairie Du Sac WI 53578-2044
Phone: (608) 643-3333
Fax: (608) 644-3852
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2880-035 | Wisconsin |
Profile Details
| NPI number | 1497814354 |
|---|---|
| LBN Legal business name | Lundgren, Gary J |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 7th, 2006 |
| Last updated | Dec 8th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497814354 | NPPES |
| Wisconsin | MEDICAID | 1497814354 |
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