Provider Demographics
NPI:1447619358
Name:LAM, MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
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 1:6113 ABERCORN AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1630
Mailing Address - Country:US
Mailing Address - Phone:423-620-7931
Mailing Address - Fax:
Practice Address - Street 1:3393 PEACHTREE RD NE
Practice Address - Street 2:SUITE B 128
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1162
Practice Address - Country:US
Practice Address - Phone:404-233-9296
Practice Address - Fax:404-841-9908
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2884152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist