Provider Demographics
NPI:1578458741
Name:RAMBO, LANCE (OD)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:RAMBO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1415 WEALTHY ST SE APT 310
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2804
Mailing Address - Country:US
Mailing Address - Phone:906-236-2550
Mailing Address - Fax:
Practice Address - Street 1:3303 ALPINE AVE NW STE A
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49544-1605
Practice Address - Country:US
Practice Address - Phone:616-649-4703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901005893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist