Provider Demographics
NPI:1144292269
Name:LAMBSON, JARED RYAN (OD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:RYAN
Last Name:LAMBSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3525
Mailing Address - Country:US
Mailing Address - Phone:903-595-0500
Mailing Address - Fax:
Practice Address - Street 1:701 W SOUTHWEST LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9410
Practice Address - Country:US
Practice Address - Phone:480-375-8908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7693-TG152W00000X
AZ01444152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB149162Medicare PIN
AZZ106159Medicare PIN