Provider Demographics
NPI:1508834821
Name:LAMBARIA, ANDRES (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:LAMBARIA
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 1:2243 ABBY CT
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-8387
Mailing Address - Country:US
Mailing Address - Phone:810-730-9790
Mailing Address - Fax:
Practice Address - Street 1:1063 S STATE RD STE 3
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1900
Practice Address - Country:US
Practice Address - Phone:810-658-2020
Practice Address - Fax:810-658-5307
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004063152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900B519890OtherBLUE CROSS BLUE SHIELD
MI4475558Medicaid
MI4475558Medicaid
0P40420Medicare PIN