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General NPI Number Information
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NPI Number | 1619318573
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Entity Type | Organization
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Legal Business Name | PHAM FAMILY OPTOMETRY
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 1375 N DAVIS RD
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City | SALINAS
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State | CA
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Zip | 93907-1991
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Country | US
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Telephone | 831-751-9917
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Fax | 831-751-9842
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Provider Business Mailing Address
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Address Line | 1375 N DAVIS RD
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City | SALINAS
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State | CA
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Zip | 93907-1991
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Country | US
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Telephone | 831-751-9917
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Fax | 831-751-9842
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MAI LAN PHAM
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Credential | O.D.
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Telephone | 831-751-9917
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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 | 14484TLG
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License Number State | CA
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