MEDICARE: JULIETT PHAN LAM O.D.

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	152W00000X	Optometrist	6784 TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942355169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIETT PHAN LAM O.D.

Provider Business Mailing Address
First Line	:	15539 FOREST CREEK FARMS DR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-4431
Country	:	US
Telephone Number	:	713-423-9532
Fax Number	:	346-456-3319

Provider Business Practice Location Address
First Line	:	13709 STATE HIGHWAY 249
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-2705
Country	:	US
Telephone Number	:	346-490-3319
Fax Number	:	346-456-4010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	09/17/2022

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