Provider Demographics
NPI:1801422902
Name:LUND, ERIC SCOTT
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:SCOTT
Last Name:LUND
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 1:1011 N JEFFERSON WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-1499
Mailing Address - Country:US
Mailing Address - Phone:515-961-6453
Mailing Address - Fax:
Practice Address - Street 1:1011 N JEFFERSON WAY STE 200
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-1499
Practice Address - Country:US
Practice Address - Phone:515-961-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA086514OtherHEARING AIDS