Healthcare Provider Details

I. General information

NPI: 1477261105
Provider Name (Legal Business Name): LOMBARD ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/11/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 ROUTE 4 STE 202
SINAJANA GU
96910-3368
US

IV. Provider business mailing address

736 ROUTE 4 STE 202
SINAJANA GU
96910-3368
US

V. Phone/Fax

Practice location:
  • Phone: 671-989-4747
  • Fax:
Mailing address:
  • Phone: 671-989-4747
  • Fax: 671-989-4743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRISTEN LOMBARD
Title or Position: OFFICE MANAGER
Credential:
Phone: 671-989-4747