Provider Demographics
NPI:1881448702
Name:LUND, ANGELA (LDO)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LUND
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 STATE ROUTE 104
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2901
Mailing Address - Country:US
Mailing Address - Phone:315-207-7044
Mailing Address - Fax:315-343-5165
Practice Address - Street 1:341 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2901
Practice Address - Country:US
Practice Address - Phone:315-207-7044
Practice Address - Fax:315-343-5165
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010247156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician