Provider Demographics
NPI:1336134667
Name:LAMM, HAROLD G (OD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:G
Last Name:LAMM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:HAROLD
Other - Middle Name:G
Other - Last Name:LAMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1605 W AVENUE N
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-4631
Mailing Address - Country:US
Mailing Address - Phone:325-653-0118
Mailing Address - Fax:325-653-4347
Practice Address - Street 1:1605 W AVENUE N
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-4631
Practice Address - Country:US
Practice Address - Phone:325-653-0118
Practice Address - Fax:325-653-4347
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2013-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3192TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093496001Medicaid
TXT14315Medicare ID - Type Unspecified
00E97BMedicare UPIN
TX0185220001Medicare NSC