Provider Demographics
NPI:1942216106
Name:LAM, VERONICA (OD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
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 1:210 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1722
Mailing Address - Country:US
Mailing Address - Phone:650-712-1234
Mailing Address - Fax:650-726-5749
Practice Address - Street 1:210 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1722
Practice Address - Country:US
Practice Address - Phone:650-712-1234
Practice Address - Fax:650-726-5749
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASD0116850152W00000X
CA11685TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist