Provider Demographics
NPI:1427023522
Name:LUNDE, ROBERT DEAN (O D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
Last Name:LUNDE
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-4924
Mailing Address - Country:US
Mailing Address - Phone:406-232-4615
Mailing Address - Fax:
Practice Address - Street 1:1909 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-3724
Practice Address - Country:US
Practice Address - Phone:406-234-7426
Practice Address - Fax:406-234-7005
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0481039Medicaid
MTM000002821Medicare PIN
MT0481039Medicaid