MEDICARE: TRAM PHAM OD, INC.

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	11732T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	SD0117320	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1629450622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAM PHAM OD, INC.

Provider Business Mailing Address
First Line	:	992 STORY RD
Second Line	:	STE 40
City	:	SAN JOSE
State	:	CA
Zip	:	95122-2674
Country	:	US
Telephone Number	:	408-920-7091
Fax Number	:	408-920-7093

Provider Business Practice Location Address
First Line	:	992 STORY RD
Second Line	:	STE 40
City	:	SAN JOSE
State	:	CA
Zip	:	95122-2674
Country	:	US
Telephone Number	:	408-920-7091
Fax Number	:	408-920-7093

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TRAM L PHAM
Credential	:	O.D.
Telephone Number	:	408-920-7091

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	06/25/2015

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