Healthcare Provider Details

I. General information

NPI: 1609936137
Provider Name (Legal Business Name): LAM N DAO OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 JEFFERSON BLVD
WARWICK RI
02888-3855
US

IV. Provider business mailing address

222 JEFFERSON BLVD
WARWICK RI
02888-3847
US

V. Phone/Fax

Practice location:
  • Phone: 401-352-0202
  • Fax: 401-738-2744
Mailing address:
  • Phone: 401-352-0202
  • Fax: 401-738-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODT0470
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: