Provider Demographics
NPI:1811027790
Name:LAMPERT, PAUL M (OD PA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:LAMPERT
Suffix:
Gender:M
Credentials:OD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-0568
Mailing Address - Country:US
Mailing Address - Phone:785-483-2291
Mailing Address - Fax:785-483-3636
Practice Address - Street 1:124 EAST WICHITA AVENUE
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-0568
Practice Address - Country:US
Practice Address - Phone:785-483-2291
Practice Address - Fax:785-483-3636
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100410300DMedicaid
KS5440480001Medicare NSC
KS100410300DMedicaid
KS651048Medicare PIN