Provider Demographics
NPI:1447225297
Name:LUNDQUIST, KURT ALLEN (OD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:ALLEN
Last Name:LUNDQUIST
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 1:34746 BITTER ROOT CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3397
Mailing Address - Country:US
Mailing Address - Phone:951-599-0866
Mailing Address - Fax:
Practice Address - Street 1:30107 HAUN RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-6825
Practice Address - Country:US
Practice Address - Phone:951-434-6291
Practice Address - Fax:951-672-2137
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9751T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU28762Medicare UPIN
CAOP9751Medicare PIN
CAU28762Medicare UPIN