Provider Demographics
NPI:1457507451
Name:ANH LAM, PA
Entity Type:Organization
Organization Name:ANH LAM, PA
Other - Org Name:BEAUTIFUL EYES/PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRISTS
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONG-ANH
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-992-5888
Mailing Address - Street 1:10420 BROADWAY ST STE C
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7852
Mailing Address - Country:US
Mailing Address - Phone:281-992-5888
Mailing Address - Fax:713-436-5154
Practice Address - Street 1:10420 BROADWAY ST STE C
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7852
Practice Address - Country:US
Practice Address - Phone:281-992-5888
Practice Address - Fax:713-436-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5587152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO81034E4Medicaid
TX5587 TGOtherTEXAS OPTOMETRY BOARD
TXPO81034E4Medicaid