Provider Demographics
NPI:1538323407
Name:LAMBART, JENNIFER LYNN (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:LAMBART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:MCCRIMMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:69001 M 62 STE E
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9131
Mailing Address - Country:US
Mailing Address - Phone:269-414-4492
Mailing Address - Fax:269-414-4493
Practice Address - Street 1:69001 M 62 STE E
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112-9131
Practice Address - Country:US
Practice Address - Phone:269-414-4492
Practice Address - Fax:269-414-4493
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003508A152W00000X
MI4901004625152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist