MEDICARE: DR. VERONICA LAM, O.D., INC.

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1396565073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. VERONICA LAM, O.D., INC.

Provider Business Mailing Address
First Line	:	210 MAIN ST
Second Line	:
City	:	HALF MOON BAY
State	:	CA
Zip	:	94019-1722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 MAIN ST
Second Line	:
City	:	HALF MOON BAY
State	:	CA
Zip	:	94019-1722
Country	:	US
Telephone Number	:	650-712-1234
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VERONICA LAM
Credential	:
Telephone Number	:	650-712-1234

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	10/16/2024

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