1427235506 NPI number — JAMES D. LUNDY, O.D., P.C.

Table of content: (NPI 1427235506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427235506 NPI number — JAMES D. LUNDY, O.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES D. LUNDY, O.D., P.C.
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:
Provider Other Organization Name Type Code:
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:
1427235506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2725 OLD MILTON PARKWAY
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-475-1777
Provider Business Mailing Address Fax Number:
770-475-1794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2725 OLD MILTON PARKWAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-475-1777
Provider Business Practice Location Address Fax Number:
770-475-1794
Provider Enumeration Date:
01/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LUNDY
Authorized Official First Name:
PANDELEE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
770-475-1777

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  886T , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 410004929 . This is a "RR MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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