Individual provider Active NPI

Stephen Lam, O.D.

  • Optometrist
  • McDonough, GA
National Provider Identifier
1316622319
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT003522 Issued in GA
Practice address
1044 Avalon Pkwy
McDonough, GA 30253-7661
Phone
(770) 898-7078
NPI assigned
Jun 16, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT003522 GA Primary

Addresses

Primary practice location

1044 Avalon Pkwy
McDonough, GA 30253-7661

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230829000356 GA Practitioner - Optometry 1052774734 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Georgia, LLCGroup PAC ID 8224261201, 100 clinicians

Practice addresses (Care Compare)

1044 Avalon Pkwy
McDonough, GA 30253-7661
Phone (770) 898-7078

4875 Altama Ave
Brunswick, GA 31520-2912
Phone (912) 554-0010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT003522GAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Georgia, LLC Optometrist CurrentSince Aug 10, 2023 Accepting new patients
Myeyedr Optometry of Georgia, LLC Optometrist Current Accepting new patients
Myeyedr Optometry of Georgia, LLC Optometrist CurrentSince Aug 10, 2023 Accepting new patients
Myeyedr Optometry of Georgia, LLC Optometrist Past Accepting new patients

Locations

2184 Henderson Mill Rd NE
Ste 12B
Atlanta, GA 30345
Phone (770) 491-1255

2549 Piedmont Rd NE
Ste 120
Atlanta, GA 30324
Phone (404) 467-0717

4875 Altama Ave
Brunswick, GA 31520
Phone (912) 554-0010

6555 Sugarloaf Pkwy
Ste 305
Duluth, GA 30097
Phone (773) 495-0937

875 Lawrenceville Suwanee Rd
Lawrenceville, GA 30043
Phone (770) 822-2199

1044 Avalon Pkwy
McDonough, GA 30253
Phone (770) 898-7078

5940 Roswell Rd
Sandy Springs, GA 30328
Phone (404) 843-2020

1000 Peachtree Industrial Blvd
Suwanee, GA 30024
Phone (770) 271-0611

1000 Peachtree Industrial Blvd
Ste 14
Suwanee, GA 30024
Phone (770) 271-0611

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1316622319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 AVALON PKWY",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302537661",
            "telephone_number": "770-898-7078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAM",
        "first_name": "STEPHEN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-16",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McDonough, GA

Sources for this page

Verify at the official NPI Registry.