Provider Demographics
NPI:1801116553
Name:LILI LAM OD & ASSOCIATES PA
Entity type:Organization
Organization Name:LILI LAM OD & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LILI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-420-5954
Mailing Address - Street 1:PO BOX 782149
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32878-2149
Mailing Address - Country:US
Mailing Address - Phone:407-243-8908
Mailing Address - Fax:
Practice Address - Street 1:120 W GRANT ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3932
Practice Address - Country:US
Practice Address - Phone:407-420-5954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
EO753AMedicare Oscar/Certification