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General NPI Number Information
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NPI Number | 1407423247
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Entity Type | Individual
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Provider Name | NGAN KIM HUYNH LAM
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Gender | Female
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 200 NOCATEE VILLAGE DR
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City | PONTE VEDRA
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State | FL
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Zip | 32081-5097
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Country | US
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Telephone | 904-825-4525
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Fax | 904-825-4520
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Provider Business Mailing Address
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Address Line | 161 HAMPTON POINT DR STE 3
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3058
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Country | US
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Telephone | 904-287-9137
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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 | OPC6062
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License Number State | FL
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