=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477261105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOMBARD ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2022
-----------------------------------------------------
Last Update Date | 11/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 736 ROUTE 4 STE 202
-----------------------------------------------------
City | SINAJANA
-----------------------------------------------------
State | GU
-----------------------------------------------------
Zip | 96910-3368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 671-989-4747
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 736 ROUTE 4 STE 202
-----------------------------------------------------
City | SINAJANA
-----------------------------------------------------
State | GU
-----------------------------------------------------
Zip | 96910-3368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 671-989-4747
-----------------------------------------------------
Fax | 671-989-4743
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | KRISTEN LOMBARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 671-989-4747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------