Provider Demographics
NPI:1780664003
Name:LUND, GENE (OD)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:
Last Name:LUND
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 1:241 DALE RD
Mailing Address - Street 2:
Mailing Address - City:BARTO
Mailing Address - State:PA
Mailing Address - Zip Code:19504
Mailing Address - Country:US
Mailing Address - Phone:610-845-0173
Mailing Address - Fax:610-253-6489
Practice Address - Street 1:3722 EASTON NAZARETH HIGHWAY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045
Practice Address - Country:US
Practice Address - Phone:610-253-6476
Practice Address - Fax:610-253-6489
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000109152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
113522OtherEXEMED (ECPA)
396303OtherCAPITOL BLUE CROSS
44274OtherDAVIS
P3186846OtherOXFORD
30243OtherAVESIS
PA0013065150002Medicaid
5685258OtherCIGNA
57359OtherAETNA
809230OtherFIRST PRIORITY
13260OtherSPECTERA
289378OtherBLUE SHIELD HIGHMARK
69643OtherOPERATING ENGINEER
410028610OtherRR MEDICARE
30243OtherAVESIS