Provider Demographics
NPI:1497056733
Name:LUNDBY, JEWEARLY (OD)
Entity Type:Individual
Prefix:
First Name:JEWEARLY
Middle Name:
Last Name:LUNDBY
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 1:52D MEDICAL GROUP
Mailing Address - Street 2:UNIT 3690
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09126
Mailing Address - Country:US
Mailing Address - Phone:314-452-8425
Mailing Address - Fax:
Practice Address - Street 1:52D MEDICAL GROUP
Practice Address - Street 2:UNIT 3690
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09126
Practice Address - Country:US
Practice Address - Phone:314-452-8425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14784152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist