Individual provider Active NPI

Jane Lam, O.D.

  • Optometrist
  • Cambridge, MA
National Provider Identifier
1881092666
Registry record updated Dec 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5067 Issued in MA
Practice address
19 Dunster St
Cambridge, MA 02138-5002
Phone
(617) 354-5590
NPI assigned
Dec 10, 2014
Last updated
Dec 10, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5067 MA Primary

Addresses

Primary practice location

19 Dunster St
Cambridge, MA 02138-5002

Mailing address

84 Concetta Sass Dr
Randolph, MA 02368-6010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20150313001810 MA Practitioner - Optometry 3375869142 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lickteig Family Eyecare PCGroup PAC ID 6002096328, 14 clinicians

Practice addresses (Care Compare)

4110 Mystic Valley Pkwy
Medford, MA 02155-6931
Phone (781) 350-7008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lickteig Family Eyecare PC Optometrist CurrentSince Sep 1, 2017 Accepting new patients

Locations

870 Providence Hwy
Dedham, MA 02026
Phone (781) 328-0067

280 School St
Ste J140
Mansfield, MA 02048
Phone (508) 594-4510

15 Brook St
Ste 3
Medfield, MA 02052

4110 Mystic Valley Pkwy
Medford, MA 02155
Phone (781) 350-7008

1245 Worcester St
Ste 1024
Natick, MA 01760
Phone (508) 653-0223

Interoperability endpoints

  • Direct secure messaging: jane.lam@direct.revolutionehr.com

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": "1418169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418169600000",
    "number": "1881092666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84 CONCETTA SASS DR",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023686010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 DUNSTER ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021385002",
            "telephone_number": "617-354-5590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAM",
        "first_name": "JANE",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-12-10",
        "last_updated": "2014-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "5067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MA

Sources for this page

Verify at the official NPI Registry.