Provider Demographics
NPI:1437102076
Name:GUNDERSON EYECARE P.C.
Entity Type:Organization
Organization Name:GUNDERSON EYECARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-481-2100
Mailing Address - Street 1:255 W 36TH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-7820
Mailing Address - Country:US
Mailing Address - Phone:812-481-2100
Mailing Address - Fax:812-481-2144
Practice Address - Street 1:255 W 36TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-7820
Practice Address - Country:US
Practice Address - Phone:812-481-2100
Practice Address - Fax:812-481-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN56000357A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5716550001Medicare NSC