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General NPI Number Information
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NPI Number | 1144574732
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Entity Type | Individual
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Provider Name | LY PHUNG LAM O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/04/2012
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 308 N LA CADENA DR
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City | COLTON
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State | CA
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Zip | 92324-2946
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Country | US
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Telephone | 909-321-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 437 N EUCLID AVE
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City | ONTARIO
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State | CA
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Zip | 91762-3456
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Country | US
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Telephone | 909-321-4700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG002712
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4952
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 33646
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License Number State | CA
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