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General NPI Number Information
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NPI Number | 1568022267
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Entity Type | Individual
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Provider Name | VANNA PHAM O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/16/2019
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 1616 CLEAR LAKE CITY BLVD STE 103
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City | HOUSTON
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State | TX
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Zip | 77062-8069
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Country | US
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Telephone | 281-286-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 2808 PICKETT DR
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City | LEAGUE CITY
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State | TX
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Zip | 77573-4857
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Country | US
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Telephone | 832-508-4964
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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 | 9674T
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License Number State | TX
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