Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1974 | AZ |
NPI | 1013327972 |
---|---|
Provider Name | Phu Minh Huynh Lam |
First Address | Tucson, AZ 85714-1167 |
Second Address | Tucson, AZ 85714-1167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 30/04/2014 |