Provider Demographics
NPI:1861495970
Name:LAM, GEORGE (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
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 1:1430 E MCANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6108
Mailing Address - Country:US
Mailing Address - Phone:541-772-7273
Mailing Address - Fax:
Practice Address - Street 1:1430 E MCANDREWS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6108
Practice Address - Country:US
Practice Address - Phone:541-772-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR116629Medicaid
R149213Medicare PIN
U35293Medicare UPIN
OR115661Medicare ID - Type Unspecified