Provider Demographics
NPI:1730230657
Name:LOMBARDI, JILLIAN ANN (OD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:ANN
Last Name:LOMBARDI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:ANN
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:11 PATTERSON PL
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1256
Mailing Address - Country:US
Mailing Address - Phone:860-510-0088
Mailing Address - Fax:
Practice Address - Street 1:18 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-3231
Practice Address - Country:US
Practice Address - Phone:860-391-1542
Practice Address - Fax:860-691-0105
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist