Provider Demographics
NPI:1699013474
Name:LUNDY, DIANE (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LUNDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 BROWN DR
Mailing Address - Street 2:
Mailing Address - City:RAMROD KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-5343
Mailing Address - Country:US
Mailing Address - Phone:305-395-0295
Mailing Address - Fax:877-427-2287
Practice Address - Street 1:352 BROWN DR
Practice Address - Street 2:
Practice Address - City:RAMROD KEY
Practice Address - State:FL
Practice Address - Zip Code:33042-5343
Practice Address - Country:US
Practice Address - Phone:305-395-0295
Practice Address - Fax:877-427-2287
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE61549207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology