Provider Demographics
NPI:1063994622
Name:OVERLORD, L.L.C.
Entity type:Organization
Organization Name:OVERLORD, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:HUY
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-421-7957
Mailing Address - Street 1:4540 DUBLIN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7564
Mailing Address - Country:US
Mailing Address - Phone:510-421-7957
Mailing Address - Fax:925-833-3985
Practice Address - Street 1:4540 DUBLIN BOULEVARD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7564
Practice Address - Country:US
Practice Address - Phone:510-421-7957
Practice Address - Fax:925-833-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier