| Vision Source Trophy Club | |
|
856 E Highway 114 Ste 100, Roanoke, TX 76262-6790 | |
| (682) 237-2103 | |
| Not Available |
| Full Name | Vision Source Trophy Club |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 856 E Highway 114 Ste 100, Roanoke, Texas |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689041634 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 8216 (Texas) | Primary |
| Provider Name | Kelvin Q Lam |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1265871222 PECOS PAC ID: 8123341104 Enrollment ID: I20141224000079 |
| Mailing Address | Practice Location Address |
|---|---|
| Vision Source Trophy Club 301 Trophy Lake Dr, Ste 128, Trophy Club, TX 76262-5238 Ph: (682) 237-2103 | Vision Source Trophy Club 856 E Highway 114 Ste 100, Roanoke, TX 76262-6790 Ph: (682) 237-2103 |
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