Provider Demographics
NPI:1356774392
Name:LAM, MEI SAN (OD)
Entity type:Individual
Prefix:
First Name:MEI
Middle Name:SAN
Last Name:LAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MEI SAN
Other - Middle Name:
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:4206 KEMP BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2845
Mailing Address - Country:US
Mailing Address - Phone:940-696-2653
Mailing Address - Fax:
Practice Address - Street 1:4206 KEMP BLVD
Practice Address - Street 2:STE. B
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2845
Practice Address - Country:US
Practice Address - Phone:940-696-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8299T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist