Provider Demographics
NPI:1043353386
Name:LAMB, MICHELLE EVA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EVA
Last Name:LAMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W SAN AUGUSTINE ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-4028
Mailing Address - Country:US
Mailing Address - Phone:281-930-0020
Mailing Address - Fax:281-930-8484
Practice Address - Street 1:310 W SAN AUGUSTINE ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-4028
Practice Address - Country:US
Practice Address - Phone:281-930-0020
Practice Address - Fax:281-930-8484
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2547TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT91176Medicare UPIN
TX00310EMedicare PIN
TX1028960001Medicare NSC