Provider Demographics
NPI:1285764167
Name:PAUL M LAMPERT OD PA
Entity type:Organization
Organization Name:PAUL M LAMPERT OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAMPERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-483-2291
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5440480001Medicare NSC
KSU83196Medicare UPIN
KS065109Medicare PIN