Provider Demographics
NPI:1710923941
Name:KUNDART, JAMES
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:KUNDART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PACIFIC UNIVERSITY COLLEGE OF OPTOMETRY
Mailing Address - Street 2:2043 COLLEGE WAY
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1797
Mailing Address - Country:US
Mailing Address - Phone:503-352-2020
Mailing Address - Fax:503-352-2929
Practice Address - Street 1:PACIFIC UNIVERSITY COLLEGE OF OPTOMETRY
Practice Address - Street 2:2043 COLLEGE WAY
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1797
Practice Address - Country:US
Practice Address - Phone:503-352-2020
Practice Address - Fax:503-352-2929
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3143T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU75361Medicare UPIN