1780664003 NPI number — GENE LUND OD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780664003 NPI number — GENE LUND OD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LUND

Provider First Name:

GENE

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

OD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1780664003

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/30/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

241 DALE RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BARTO

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

19504

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-845-0173

Provider Business Mailing Address Fax Number:

610-253-6489

Provider First Line Business Practice Location Address:

3722 EASTON NAZARETH HIGHWAY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

EASTON

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18045

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

610-253-6476

Provider Business Practice Location Address Fax Number:

610-253-6489

Provider Enumeration Date:

01/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  OEG000109 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 113522 . This is a "EXEMED (ECPA)" identifier . This identifiers is of the category "OTHER".
• Identifier: 396303 . This is a "CAPITOL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
• Identifier: 44274 . This is a "DAVIS" identifier . This identifiers is of the category "OTHER".
• Identifier: P3186846 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 30243 . This is a "AVESIS" identifier . This identifiers is of the category "OTHER".
• Identifier: 0013065150002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 5685258 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 57359 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 809230 . This is a "FIRST PRIORITY" identifier . This identifiers is of the category "OTHER".
• Identifier: 13260 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
• Identifier: 289378 . This is a "BLUE SHIELD HIGHMARK" identifier . This identifiers is of the category "OTHER".
• Identifier: 69643 . This is a "OPERATING ENGINEER" identifier . This identifiers is of the category "OTHER".
• Identifier: 410028610 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".