Provider Demographics
NPI:1417782301
Name:LAMBERT, KELLIANNE PATRICE (OD)
Entity type:Individual
Prefix:
First Name:KELLIANNE
Middle Name:PATRICE
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 FAIRWAY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-7706
Mailing Address - Country:US
Mailing Address - Phone:903-576-5657
Mailing Address - Fax:
Practice Address - Street 1:200 S COLLEGE ST STE 307
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2065
Practice Address - Country:US
Practice Address - Phone:704-334-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist