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General NPI Number Information
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NPI Number | 1255746947
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Entity Type | Individual
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Provider Name | KIM NGAN THI PHAM O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2014
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 2655 GULF TO BAY BLVD PHAMILY EYE CARE OPTICAL
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City | CLEARWATER
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State | FL
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Zip | 33759
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Country | US
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Telephone | 727-373-1954
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Fax |
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Provider Business Mailing Address
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Address Line | 2655 GULF TO BAY BLVD PHAMILY EYE CARE OPTICAL
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City | CLEARWATER
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State | FL
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Zip | 33759
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Country | US
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Telephone | 727-373-1954
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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 | OPC 4926
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License Number State | FL
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