Provider Demographics
NPI:1598829111
Name:BUNDY, JOSEPH (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BUNDY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GOLDFINCH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-2311
Mailing Address - Country:US
Mailing Address - Phone:507-420-6603
Mailing Address - Fax:
Practice Address - Street 1:1001 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4456
Practice Address - Country:US
Practice Address - Phone:507-238-9490
Practice Address - Fax:507-238-9038
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1829152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN437023600Medicaid
MNT39733Medicare UPIN
MN437023600Medicaid