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General NPI Number Information
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NPI Number | 1437573235
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Entity Type | Individual
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Provider Name | KIMBERLY Q. PHAM O.D
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Gender | Female
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 501 S AUSTIN AVE UNIT 1145
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City | GEORGETOWN
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State | TX
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Zip | 78626-5640
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Country | US
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Telephone | 737-225-8644
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Fax |
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Provider Business Mailing Address
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Address Line | 501 S AUSTIN AVE UNIT 1145
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City | GEORGETOWN
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State | TX
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Zip | 78626-5640
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Country | US
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Telephone | 737-225-8644
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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 | 8347TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14799
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License Number State | CA
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