1114070869 NPI number — DRS. LUNDBERG AND LODWICK, OPTOMETRISTS PC

Table of content: (NPI 1114070869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114070869 NPI number — DRS. LUNDBERG AND LODWICK, OPTOMETRISTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS. LUNDBERG AND LODWICK, OPTOMETRISTS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WILLIAMSBURG EYE CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114070869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 BULIFANTS BLVD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23188-5721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-564-1907
Provider Business Mailing Address Fax Number:
757-564-1913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 BULIFANTS BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188-5721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-564-1907
Provider Business Practice Location Address Fax Number:
757-564-1913
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LODWICK
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
KENNETH
Authorized Official Title or Position:
OWNER-PARTNER
Authorized Official Telephone Number:
757-564-1907

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1367 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9552508 . This is a "RICHARD LODWICK, OD CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 124444 . This is a "PAMELA LUNDBERG OD OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9230491 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 76039 . This is a "RICHARD LODWICK OD OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010050308 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1346269560 . This is a "RICHARD LODWICK, OD NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2120419 . This is a "RICHARD LODWICK, OD MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2894306 . This is a "PAMELA LUNDBERG, OD CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1215012679 . This is a "PAMELA LUNDBERG, OD NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 238395 . This is a "PAMELA LUNDBERG, OD MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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