Provider Demographics
NPI:1306914247
Name:LAM, SEAN CUONG (OD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:CUONG
Last Name:LAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10304 BLACKHAWK BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-2798
Mailing Address - Country:US
Mailing Address - Phone:713-987-5555
Mailing Address - Fax:713-987-5557
Practice Address - Street 1:10304 BLACKHAWK BLVD
Practice Address - Street 2:STE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-2798
Practice Address - Country:US
Practice Address - Phone:713-987-5555
Practice Address - Fax:713-987-5557
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6507TG152W00000X, 152WC0802X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1771693Medicaid
TX1771693Medicaid
TX8D0027Medicare PIN