Provider Demographics
NPI:1922079730
Name:LAMBERSON & MALOTT EYE CENTER, P.C.
Entity Type:Organization
Organization Name:LAMBERSON & MALOTT EYE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAMBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-521-0675
Mailing Address - Street 1:375 TROJAN LN
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-2966
Mailing Address - Country:US
Mailing Address - Phone:765-521-0675
Mailing Address - Fax:765-593-0703
Practice Address - Street 1:375 TROJAN LN
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2966
Practice Address - Country:US
Practice Address - Phone:765-521-0675
Practice Address - Fax:765-593-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001789B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0430110001Medicare NSC