Provider Demographics
NPI:1124487020
Name:LUNDY, SAIA AMOURIS
Entity type:Individual
Prefix:MISS
First Name:SAIA
Middle Name:AMOURIS
Last Name:LUNDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18620 HATTERAS ST
Mailing Address - Street 2:SUITE NUMBER 210
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1832
Mailing Address - Country:US
Mailing Address - Phone:818-429-3756
Mailing Address - Fax:
Practice Address - Street 1:18620 HATTERAS ST
Practice Address - Street 2:SUITE NUMBER 210
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1832
Practice Address - Country:US
Practice Address - Phone:818-429-3756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA196557156FC0800X, 156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter