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General NPI Number Information
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NPI Number | 1598129769
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Entity Type | Organization
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Legal Business Name | JASON LAM O.D., M.B.A., INC.
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 2620 TUSCANY ST SUITE 103
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City | CORONA
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State | CA
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Zip | 92881-4646
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Country | US
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Telephone | 951-372-9623
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Fax | 951-372-9683
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Provider Business Mailing Address
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Address Line | 265 W DUARTE RD
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City | ARCADIA
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State | CA
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Zip | 91007-6922
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Country | US
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Telephone | 805-870-5261
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. JASON LAM
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Credential | OD, MBA
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Telephone | 951-372-9623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 13261
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License Number State | CA
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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 | 13261
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License Number State | CA
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