Provider Demographics
NPI:1598129769
Name:JASON LAM O.D., M.B.A., INC.
Entity Type:Organization
Organization Name:JASON LAM O.D., M.B.A., INC.
Other - Org Name:EYEKONIC FAMILY OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MBA
Authorized Official - Phone:951-372-9623
Mailing Address - Street 1:265 W DUARTE RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6922
Mailing Address - Country:US
Mailing Address - Phone:805-870-5261
Mailing Address - Fax:
Practice Address - Street 1:2620 TUSCANY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-4646
Practice Address - Country:US
Practice Address - Phone:951-372-9623
Practice Address - Fax:951-372-9683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13261152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty