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General NPI Number Information
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NPI Number | 1578113981
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Entity Type | Organization
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Legal Business Name | JOANN D. PHAM OD PA
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 318 E PALMETTO PARK RD
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City | BOCA RATON
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State | FL
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Zip | 33432-5016
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Country | US
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Telephone | 561-338-0081
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Fax |
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Provider Business Mailing Address
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Address Line | 300 S AUSTRALIAN AVE UNIT 425
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5090
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Country | US
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Telephone | 561-373-3049
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JOANN PHAM PARISE
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Credential | OD
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Telephone | 561-373-3049
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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 |
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License Number State |
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