Provider Demographics
NPI:1720343478
Name:LAM, VALERIE ELAINE (OD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:ELAINE
Last Name:LAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:ELAINE
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3151 AIRWAY AVE STE J2
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4624
Mailing Address - Country:US
Mailing Address - Phone:310-346-5224
Mailing Address - Fax:
Practice Address - Street 1:3151 AIRWAY AVE STE J2
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4624
Practice Address - Country:US
Practice Address - Phone:310-346-5224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14389152W00000X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy