Provider Demographics
NPI:1003896838
Name:LAMB, JANE W (OD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:W
Last Name:LAMB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 S FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-1602
Mailing Address - Country:US
Mailing Address - Phone:334-335-6544
Mailing Address - Fax:
Practice Address - Street 1:288 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-1602
Practice Address - Country:US
Practice Address - Phone:334-335-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS319TA226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68959Medicare UPIN
AL1197380001Medicare NSC