=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831780865
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE TESTING SPECIALISTS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2021
-----------------------------------------------------
Last Update Date | 02/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5154 MILLER RD STE J
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48507-1069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-658-2020
-----------------------------------------------------
Fax | 810-658-5307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1063 S STATE RD STE 3
-----------------------------------------------------
City | DAVISON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48423-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-658-2020
-----------------------------------------------------
Fax | 810-658-5307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANDRES LAMBARIA
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 810-730-9790
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------