Provider Demographics
NPI:1215012679
Name:LUNDBERG, PAMELA DAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DAWN
Last Name:LUNDBERG
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 1:101 BULIFANTS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5709
Mailing Address - Country:US
Mailing Address - Phone:757-564-1907
Mailing Address - Fax:757-564-1913
Practice Address - Street 1:101 BULIFANTS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5709
Practice Address - Country:US
Practice Address - Phone:757-564-1907
Practice Address - Fax:757-564-1913
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009230491Medicaid
VAU25114Medicare UPIN
VAL04095201Medicare PIN