Provider Demographics
NPI:1912196692
Name:DR. MYLINH LAM O.D, INC
Entity Type:Organization
Organization Name:DR. MYLINH LAM O.D, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYLINH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-444-0369
Mailing Address - Street 1:10921 VALLEY MALL
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2615
Mailing Address - Country:US
Mailing Address - Phone:626-444-0369
Mailing Address - Fax:626-444-1957
Practice Address - Street 1:10921 VALLEY MALL
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2615
Practice Address - Country:US
Practice Address - Phone:626-444-0369
Practice Address - Fax:626-444-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10766T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0107660Medicaid
CAWY198Medicare PIN