MEDICARE: DR. JERRY B. LAMBERSON O. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18001789B	IN

General Provider Information

NPI Number	:	1295723427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY B. LAMBERSON O. D.

Provider Business Mailing Address
First Line	:	375 TROJAN LN
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-2966
Country	:	US
Telephone Number	:	765-521-0675
Fax Number	:	765-593-0703

Provider Business Practice Location Address
First Line	:	375 TROJAN LN
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-2966
Country	:	US
Telephone Number	:	765-521-0675
Fax Number	:	765-593-0703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	02/20/2008

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