Individual
JESSICA LAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
930 MADISON AVE STE 200, MEMPHIS, TN 38103-3452
(901) 448-6650
Mailing address
1407 UNION AVE STE 700, MEMPHIS, TN 38104-3641
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3395
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01788595
—
MS
05
—
1699138222
—
MO
05
—
Q031054
—
TN
Enumeration date
03/31/2016
Last updated
02/01/2019
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