Provider Demographics
NPI:1407823933
Name:UNDERWOOD, LANCE E (OD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:E
Last Name:UNDERWOOD
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 1:915 N DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1013
Mailing Address - Country:US
Mailing Address - Phone:302-651-4413
Mailing Address - Fax:302-651-4445
Practice Address - Street 1:915 N DUPONT BLVD STE 1
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963
Practice Address - Country:US
Practice Address - Phone:302-651-4413
Practice Address - Fax:302-651-4445
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE130001298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE161525705OtherBCBSDE
DE1000038371Medicaid
DE1000038371Medicaid