Provider Demographics
NPI:1417933250
Name:LAM, ANITA S (OD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:S
Last Name:LAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1101 MADISON ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1306
Mailing Address - Country:US
Mailing Address - Phone:206-215-2004
Mailing Address - Fax:206-215-2055
Practice Address - Street 1:1455 NW LEARY WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5124
Practice Address - Country:US
Practice Address - Phone:206-784-3350
Practice Address - Fax:206-781-8693
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOD00003728152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029080Medicaid
WA0187378OtherLABOR & INDUSTRIES
8647LAOtherREGENCE HEALTHCARE
WA2029080Medicaid
WA8872935Medicare PIN