Healthcare Provider Details

I. General information

NPI: 1982845319
Provider Name (Legal Business Name): DUY PHAM O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 09/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 MING AVE SUITE D
BAKERSFIELD CA
93304-4139
US

IV. Provider business mailing address

3216 MING AVE SUITE D
BAKERSFIELD CA
93304-4139
US

V. Phone/Fax

Practice location:
  • Phone: 661-834-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: