MEDICARE: VIVIAN LAM

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	152WL0500X	Low Vision Rehabilitation Optometrist	0618003536	VA
2	152WP0200X	Pediatric Optometrist	0618003536	VA
3	152W00000X	Optometrist	0618003536	VA

General Provider Information

NPI Number	:	1982594586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN LAM

Provider Business Mailing Address
First Line	:	25055 RIDING PLZ STE 100
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-5918
Country	:	US
Telephone Number	:	703-957-3384
Fax Number	:

Provider Business Practice Location Address
First Line	:	25055 RIDING PLZ STE 100
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-5918
Country	:	US
Telephone Number	:	703-957-3384
Fax Number	:	703-957-3387

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

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	07/07/2025

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Directions to “ VIVIAN LAM ” Practice Location

Language	Start Address	Practice Location

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