Provider Demographics
NPI:1063597201
Name:LAM, IRENE H (OD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:H
Last Name:LAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2815 N CLASSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-5419
Mailing Address - Country:US
Mailing Address - Phone:405-528-8200
Mailing Address - Fax:405-528-8201
Practice Address - Street 1:2815 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5419
Practice Address - Country:US
Practice Address - Phone:405-528-8200
Practice Address - Fax:405-528-8201
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2090152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1123245OtherUNITED HEALTHCARE
OK5117339OtherAETNA
OK100759520AMedicaid
OK122311OtherEYE MED VISION / CMVS
OK5117339OtherAETNA
OK4379520002Medicare NSC
OK16258OtherSPECTERA