Provider Demographics
NPI:1801811641
Name:HERMAN L. RUNDLE, M.D. INC
Entity type:Organization
Organization Name:HERMAN L. RUNDLE, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:RUNDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-558-2822
Mailing Address - Street 1:1031 W CHAPMAN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2826
Mailing Address - Country:US
Mailing Address - Phone:714-558-2822
Mailing Address - Fax:714-835-3726
Practice Address - Street 1:1031 W CHAPMAN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2826
Practice Address - Country:US
Practice Address - Phone:714-558-2822
Practice Address - Fax:714-835-3726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG9113207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G91130Medicaid
CA000G91130Medicaid
CAWG9113BMedicare PIN
CAA58814Medicare UPIN
CA000G91130Medicaid