MEDICARE: KHANH PHAM OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9958T	TX

General Provider Information

NPI Number	:	1326664475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHANH PHAM OD

Provider Business Mailing Address
First Line	:	26435 KUYKENDAHL RD STE 800
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-1855
Country	:	US
Telephone Number	:	832-554-1100
Fax Number	:	832-639-0015

Provider Business Practice Location Address
First Line	:	26435 KUYKENDAHL RD STE 800
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-1855
Country	:	US
Telephone Number	:	832-554-1100
Fax Number	:	832-639-0015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	04/08/2024

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