=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437526803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. KRYSTINA PHAM & ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2015
-----------------------------------------------------
Last Update Date | 03/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6185 RETAIL RD STE 210
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-7807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-232-2010
-----------------------------------------------------
Fax | 469-232-2010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3613 HUTCH DR
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75074-8965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-552-4833
-----------------------------------------------------
Fax | 469-232-2010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, OPTOMETRIST
-----------------------------------------------------
Name | DR. KRYSTINA PHAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-552-4833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 6326T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------