Provider Demographics
NPI:1295723427
Name:LAMBERSON, JERRY B (O D)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:B
Last Name:LAMBERSON
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001789B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN354420AMedicare PIN
INT34686Medicare UPIN
IN0430110001Medicare NSC