Healthcare Provider Details

I. General information

NPI: 1336611367
Provider Name (Legal Business Name): BLOSSOM VALLEY OPTOMETRY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 BLOSSOM HILL RD
SAN JOSE CA
95123-3212
US

IV. Provider business mailing address

590 BLOSSOM HILL RD
SAN JOSE CA
95123-3212
US

V. Phone/Fax

Practice location:
  • Phone: 408-227-2020
  • Fax:
Mailing address:
  • Phone: 408-227-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. PHUONG PHAM
Title or Position: OWNER
Credential: O.D.
Phone: 408-807-4344