Healthcare Provider Details

I. General information

NPI: 1457214496
Provider Name (Legal Business Name): FM OPTOMETRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 23RD AVE E
WEST FARGO ND
58078-7804
US

IV. Provider business mailing address

750 23RD AVE E
WEST FARGO ND
58078-7804
US

V. Phone/Fax

Practice location:
  • Phone: 701-281-2237
  • Fax: 701-281-2236
Mailing address:
  • Phone: 701-281-2237
  • Fax: 701-281-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANDREW VIET PHAM
Title or Position: OPTOMETRIST
Credential: OD
Phone: 320-766-7778