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General NPI Number Information
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NPI Number | 1013370535
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Entity Type | Individual
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Provider Name | ZACHARY LUNDGREN OD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 1603 SOUTHBROOK LN
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City | WADENA
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State | MN
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Zip | 56482-2110
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Country | US
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Telephone | 218-371-7022
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Fax |
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Provider Business Mailing Address
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Address Line | 1603 SOUTHBROOK LN
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City | WADENA
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State | MN
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Zip | 56482-2110
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Country | US
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Telephone | 218-371-7022
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3339
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License Number State | CO
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