Provider Demographics
NPI:1952966152
Name:STEPHEN LUNDQUIST, O.D., P.C.
Entity Type:Organization
Organization Name:STEPHEN LUNDQUIST, O.D., P.C.
Other - Org Name:VIS.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:LUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-410-4281
Mailing Address - Street 1:801 S 800 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3515
Mailing Address - Country:US
Mailing Address - Phone:801-410-4281
Mailing Address - Fax:
Practice Address - Street 1:801 S 800 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3515
Practice Address - Country:US
Practice Address - Phone:801-819-9084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty