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General NPI Number Information
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NPI Number | 1417407982
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Entity Type | Organization
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Legal Business Name | PREMIUM EYECARE & ASSOCIATES PLLC
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Dates
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Enumeration Date | 10/09/2016
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 28404 HIGHWAY 290 SUITE G13
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City | CYPRESS
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State | TX
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Zip | 77433-4288
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Country | US
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Telephone | 281-817-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 28404 HIGHWAY 290 SUITE G13
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City | CYPRESS
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State | TX
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Zip | 77433-5426
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. CANDACE MARIE PHAM
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Credential | O.D.
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Telephone | 832-729-9375
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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 | 7426
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License Number State | TX
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