Provider Demographics
NPI:1851637474
Name:LAM OCULOFACIAL PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:LAM OCULOFACIAL PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:BASAN
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-607-6888
Mailing Address - Street 1:1740 SOUTH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146
Mailing Address - Country:US
Mailing Address - Phone:267-607-6888
Mailing Address - Fax:267-393-4310
Practice Address - Street 1:1740 SOUTH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146
Practice Address - Country:US
Practice Address - Phone:267-607-6888
Practice Address - Fax:267-393-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440839207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty