Provider Demographics
NPI:1992010490
Name:LAM, WENDY (OD)
Entity Type:Individual
Prefix:
First Name:WENDY
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 1:119 S L ST
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-2324
Mailing Address - Country:US
Mailing Address - Phone:559-591-4656
Mailing Address - Fax:559-591-4090
Practice Address - Street 1:119 S L ST
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-2324
Practice Address - Country:US
Practice Address - Phone:559-591-4656
Practice Address - Fax:559-591-4090
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14038152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist