Healthcare Provider Details

I. General information

NPI: 1043798994
Provider Name (Legal Business Name): HUONG PHAM OPTOMETRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14251 EUCLID ST STE F101
GARDEN GROVE CA
92843-4957
US

IV. Provider business mailing address

14251 EUCLID ST STE F101
GARDEN GROVE CA
92843-4957
US

V. Phone/Fax

Practice location:
  • Phone: 714-265-2197
  • Fax: 714-265-2411
Mailing address:
  • Phone: 714-265-2197
  • Fax: 714-265-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number10462
License Number StateCA

VIII. Authorized Official

Name: DR. HUONG T PHAM
Title or Position: CEO
Credential: OD
Phone: 714-265-2197