Provider Demographics
NPI:1376931329
Name:ADVANCED EYECARE, LLC
Entity Type:Organization
Organization Name:ADVANCED EYECARE, LLC
Other - Org Name:LOMBARD HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMBARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-777-5055
Mailing Address - Street 1:736 ROUTE 4
Mailing Address - Street 2:STE 103
Mailing Address - City:SINAJANA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-3368
Mailing Address - Country:US
Mailing Address - Phone:671-989-4747
Mailing Address - Fax:671-989-4743
Practice Address - Street 1:736 ROUTE 4
Practice Address - Street 2:STE 103
Practice Address - City:SINAJANA
Practice Address - State:GU
Practice Address - Zip Code:96910-3368
Practice Address - Country:US
Practice Address - Phone:671-988-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUMD-1687207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUHC068ZMedicare UPIN