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General NPI Number Information
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NPI Number | 1588831754
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Entity Type | Individual
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Provider Name | LUKE HUY-VIET PHAM RDO
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Gender | Male
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 5305 NE 121ST AVE STE N501
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City | VANCOUVER
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State | WA
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Zip | 98682-6202
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Country | US
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Telephone | 360-314-2826
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Fax | 360-828-7338
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Provider Business Mailing Address
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Address Line | 5305 NE 121ST AVE, STE N501
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City | VANCOUVER
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State | WA
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Zip | 98682-6202
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Country | US
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Telephone | 360-314-2826
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Fax | 360-828-7338
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | D 6055
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License Number State | CA
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