Provider Demographics
NPI:1013184597
Name:MUNDT, JAMES DAVID
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:MUNDT
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 1:5401 FM 1626
Mailing Address - Street 2:STE 135
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6038
Mailing Address - Country:US
Mailing Address - Phone:512-268-7850
Mailing Address - Fax:
Practice Address - Street 1:5401 FM 1626
Practice Address - Street 2:STE 135
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6038
Practice Address - Country:US
Practice Address - Phone:512-268-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician