Provider Demographics
NPI:1619075587
Name:LAM, WING CHRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:WING
Middle Name:CHRISTINE
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 1:3606 MONARCH CT
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9210
Mailing Address - Country:US
Mailing Address - Phone:304-292-7240
Mailing Address - Fax:
Practice Address - Street 1:730 VENTURE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-7306
Practice Address - Country:US
Practice Address - Phone:304-292-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV980-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3101012000Medicaid
WVU91684Medicare UPIN
WVLA4091111Medicare ID - Type Unspecified