Provider Demographics
NPI:1225465214
Name:TAM, MICHAEL H (OD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:H
Last Name:TAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 NW GILMAN BLVD
Mailing Address - Street 2:SUITE G-12
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-391-9331
Mailing Address - Fax:
Practice Address - Street 1:1145 NW GILMAN BLVD
Practice Address - Street 2:SUITE G-12
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-391-9331
Practice Address - Fax:425-427-8973
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003507TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist