Individual provider Active NPI

Michael Lam, O.D.

  • Optometrist
  • Marietta, GA
National Provider Identifier
1447619358
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2884 Issued in GA
Practice address
850 Old Piedmont Rd
Marietta, GA 30066-5490
Phone
(770) 422-3677
Fax
(770) 422-5814
NPI assigned
Feb 19, 2016
Last updated
Dec 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2884 GA Primary

Addresses

Primary practice location

850 Old Piedmont Rd
Marietta, GA 30066-5490

Mailing address

850 Old Piedmont Rd
Marietta, GA 30066-5490
Phone (770) 422-3677

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
I20250218002542 GA Practitioner - Optometry 2961922141 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Old Piedmont Eye Group LLCGroup PAC ID 1052831237, 2 clinicians

Practice addresses (Care Compare)

850 Old Piedmont Rd
Marietta, GA 30066-5490
Phone (770) 422-3677

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2884GAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Old Piedmont Eye Group LLC Optometrist CurrentSince Dec 24, 2024 Accepting new patients

Locations

850 Old Piedmont Rd
Marietta, GA 30066
Phone (770) 422-3677

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1455840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1447619358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 OLD PIEDMONT RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300665490",
            "telephone_number": "770-422-3677",
            "fax_number": "770-422-5814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 OLD PIEDMONT RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300665490",
            "telephone_number": "770-422-3677",
            "fax_number": "770-422-5814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAM",
        "first_name": "MICHAEL",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-19",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "2884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.