Provider Demographics
NPI:1942355169
Name:LAM, JULIETT PHAN (OD)
Entity Type:Individual
Prefix:
First Name:JULIETT
Middle Name:PHAN
Last Name:LAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIETT
Other - Middle Name:QUOC
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:15539 FOREST CREEK FARMS DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4431
Mailing Address - Country:US
Mailing Address - Phone:713-423-9532
Mailing Address - Fax:346-456-3319
Practice Address - Street 1:13709 STATE HIGHWAY 249
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-2705
Practice Address - Country:US
Practice Address - Phone:346-490-3319
Practice Address - Fax:346-456-4010
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6784 TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186674101Medicaid
TX8J4521Medicare PIN