MEDICARE: PHONG 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	8050T	TX

General Provider Information

NPI Number	:	1750636064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHONG PHAM O.D.

Provider Business Mailing Address
First Line	:	1250 UVALDE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10117 W GRAND PKWY S
Second Line	:	STE 101
City	:	RICHMOND
State	:	TX
Zip	:	77407-8643
Country	:	US
Telephone Number	:	832-781-2020
Fax Number	:	832-403-3151

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

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	10/04/2019

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Directions to “ PHONG PHAM O.D.” Practice Location

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