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General NPI Number Information
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NPI Number | 1114070869
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Entity Type | Organization
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Legal Business Name | DRS. LUNDBERG AND LODWICK, OPTOMETRISTS PC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 101 BULIFANTS BLVD STE A
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-5721
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Country | US
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Telephone | 757-564-1907
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Fax | 757-564-1913
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Provider Business Mailing Address
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Address Line | 101 BULIFANTS BLVD STE A
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-5721
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Country | US
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Telephone | 757-564-1907
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Fax | 757-564-1913
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Authorized Official
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Title or Position | OWNER-PARTNER
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Name | DR. RICHARD KENNETH LODWICK
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Credential | O.D.
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Telephone | 757-564-1907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1367
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License Number State | VA
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