Provider Demographics
NPI:1467430413
Name:LAM, LIEN (OD)
Entity Type:Individual
Prefix:DR
First Name:LIEN
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 ALTAMESA BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5641
Mailing Address - Country:US
Mailing Address - Phone:817-346-2020
Mailing Address - Fax:817-370-1655
Practice Address - Street 1:3608 ALTAMESA BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5641
Practice Address - Country:US
Practice Address - Phone:817-346-2020
Practice Address - Fax:817-370-1655
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6162TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C0227Medicare ID - Type UnspecifiedTARRANT COUNTY
TXV00245Medicare UPIN