Healthcare Provider Details

I. General information

NPI: 1639331465
Provider Name (Legal Business Name): JEREMY DEAN LAMB O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 12/06/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3567
  • Fax:
Mailing address:
  • Phone: 760-719-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7053664-9934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: