Provider Demographics
NPI:1194379479
Name:LAMBERT, KEVIN ROBERT (OD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ROBERT
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 1:158 RIVERTON STOCKYARD ROAD
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WV
Mailing Address - Zip Code:26814
Mailing Address - Country:US
Mailing Address - Phone:304-902-0411
Mailing Address - Fax:
Practice Address - Street 1:205 CHENOWETH CREEK RD
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-636-3887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2061-IOD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist