Provider Demographics
NPI:1043239742
Name:LAM, MAN-WA (OD)
Entity Type:Individual
Prefix:DR
First Name:MAN-WA
Middle Name:
Last Name:LAM
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 1:4313 DELORES DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4813
Mailing Address - Country:US
Mailing Address - Phone:510-675-9978
Mailing Address - Fax:510-675-9978
Practice Address - Street 1:34420 FREMONT BLVD
Practice Address - Street 2:SUITE # E
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-3323
Practice Address - Country:US
Practice Address - Phone:510-796-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9783 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU085ZMedicare PIN
CAAU085Medicare PIN
CASD0097830Medicare ID - Type Unspecified
CAAU085XMedicare PIN
CAAU085YMedicare PIN