Provider Demographics
NPI:1598819351
Name:LAM, ON (OD)
Entity Type:Individual
Prefix:MR
First Name:ON
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 1:7517 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6537
Mailing Address - Country:US
Mailing Address - Phone:718-779-1222
Mailing Address - Fax:718-554-7974
Practice Address - Street 1:7517 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6537
Practice Address - Country:US
Practice Address - Phone:718-779-1222
Practice Address - Fax:718-554-7974
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02277925Medicaid
NYU89482Medicare UPIN
NY05064Medicare PIN