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General NPI Number Information
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NPI Number | 1245801125
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Entity Type | Individual
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Provider Name | WENDY UYEN PHAM
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Gender | Female
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 1668 E 2ND ST STE B
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City | BEAUMONT
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State | CA
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Zip | 92223-3168
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Country | US
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Telephone | 951-845-4749
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 BARTON RD APT 806
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City | REDLANDS
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State | CA
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Zip | 92373-5490
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Country | US
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Telephone | 714-386-2087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 34869
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License Number State | CA
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