MEDICARE: DR. MAN-WA LAM O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9783 T	CA

General Provider Information

NPI Number	:	1043239742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAN-WA LAM O.D.

Provider Business Mailing Address
First Line	:	4313 DELORES DR
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4813
Country	:	US
Telephone Number	:	510-675-9978
Fax Number	:	510-675-9978

Provider Business Practice Location Address
First Line	:	34420 FREMONT BLVD
Second Line	:	SUITE # E
City	:	FREMONT
State	:	CA
Zip	:	94555-3323
Country	:	US
Telephone Number	:	510-796-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	02/11/2009

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