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General NPI Number Information
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NPI Number | 1336719046
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Entity Type | Individual
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Provider Name | VINCENT MINH PHAM OD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2021
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 3155D SEDONA CT
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City | ONTARIO
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State | CA
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Zip | 91764-6555
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Country | US
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Telephone | 909-698-9780
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Fax |
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Provider Business Mailing Address
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Address Line | 2876 SAWGRASS DR
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City | SANTA ANA
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State | CA
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Zip | 92706-1145
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Country | US
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Telephone | 714-414-3665
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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 | 35001-TLG
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10236T
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License Number State | TX
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