MEDICARE: DR. KIMBERLY Q. PHAM O.D

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	8347TG	TX
2	152W00000X	Optometrist	14799	CA

General Provider Information

NPI Number	:	1437573235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY Q. PHAM O.D

Provider Business Mailing Address
First Line	:	501 S AUSTIN AVE UNIT 1145
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-5640
Country	:	US
Telephone Number	:	737-225-8644
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S AUSTIN AVE UNIT 1145
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-5640
Country	:	US
Telephone Number	:	737-225-8644
Fax Number	:

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

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	06/28/2023

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