Provider Demographics
NPI:1437209046
Name:LAM, BENH D (OD)
Entity Type:Individual
Prefix:
First Name:BENH
Middle Name:D
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 1:4315 FANDON AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-1917
Mailing Address - Country:US
Mailing Address - Phone:626-232-1560
Mailing Address - Fax:
Practice Address - Street 1:2100 N BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3126
Practice Address - Country:US
Practice Address - Phone:562-431-3066
Practice Address - Fax:562-431-3969
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP12427Medicare ID - Type Unspecified
CAU96418Medicare UPIN