Provider Demographics
NPI:1114070869
Name:DRS. LUNDBERG AND LODWICK, OPTOMETRISTS PC
Entity Type:Organization
Organization Name:DRS. LUNDBERG AND LODWICK, OPTOMETRISTS PC
Other - Org Name:WILLIAMSBURG EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:LODWICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-564-1907
Mailing Address - Street 1:101 BULIFANTS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5721
Mailing Address - Country:US
Mailing Address - Phone:757-564-1907
Mailing Address - Fax:757-564-1913
Practice Address - Street 1:101 BULIFANTS BLVD STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5721
Practice Address - Country:US
Practice Address - Phone:757-564-1907
Practice Address - Fax:757-564-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9552508OtherRICHARD LODWICK, OD CIGNA
VA124444OtherPAMELA LUNDBERG OD OPTIMA
VA9230491Medicaid
VA76039OtherRICHARD LODWICK OD OPTIMA
VA010050308Medicaid
VA1346269560OtherRICHARD LODWICK, OD NPI
VA2120419OtherRICHARD LODWICK, OD MAMSI
VA2894306OtherPAMELA LUNDBERG, OD CIGNA
VA1215012679OtherPAMELA LUNDBERG, OD NPI
VA238395OtherPAMELA LUNDBERG, OD MAMSI
VA1346269560OtherRICHARD LODWICK, OD NPI
VA0974810001Medicare NSC
VA1215012679OtherPAMELA LUNDBERG, OD NPI
VA9230491Medicaid
VA1346269560OtherRICHARD LODWICK, OD NPI