Healthcare Provider Details

I. General information

NPI: 1063994622
Provider Name (Legal Business Name): OVERLORD, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 DUBLIN BOULEVARD
DUBLIN CA
94568-7564
US

IV. Provider business mailing address

4540 DUBLIN BOULEVARD
DUBLIN CA
94568-7564
US

V. Phone/Fax

Practice location:
  • Phone: 510-421-7957
  • Fax: 925-833-3985
Mailing address:
  • Phone: 510-421-7957
  • Fax: 925-833-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: ANDY HUY NGUYEN
Title or Position: PRESIDENT
Credential:
Phone: 510-421-7957