Provider Demographics
NPI:1114282258
Name:LAMBERT, RAYMOND JOHN (OD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOHN
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 S CLIFF AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6954
Mailing Address - Country:US
Mailing Address - Phone:816-478-1230
Mailing Address - Fax:816-350-4585
Practice Address - Street 1:1613 S 7 HWY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-3946
Practice Address - Country:US
Practice Address - Phone:816-478-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1911152W00000X
IDODP-100253152W00000X
TNOD0000003234152W00000X
WAOD 60299099152W00000X
MO2016039155152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ162075Medicare PIN
AZZ162816Medicare PIN