Provider Demographics
NPI:1932168804
Name:LAM, CHRISTINA W (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:W
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 1:3132 SEAPORT CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2740
Mailing Address - Country:US
Mailing Address - Phone:907-337-9794
Mailing Address - Fax:
Practice Address - Street 1:601 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:STE L
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2811
Practice Address - Country:US
Practice Address - Phone:907-277-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK220152W00000X
TX6532T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD 2201Medicaid
AK160048Medicare ID - Type UnspecifiedNON PARTICIPATING
AKOD 2201Medicaid