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General NPI Number Information
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NPI Number | 1730565292
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Entity Type | Individual
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Provider Name | TOMMY TAN PHAM
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Gender | Male
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 08/07/2015
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Provider Practice Location Address
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Address Line | 3848 VETERANS MEMORIAL BLVD # 202
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City | METAIRIE
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State | LA
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Zip | 70002-5671
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Country | US
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Telephone | 225-205-7060
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Fax |
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Provider Business Mailing Address
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Address Line | 3848 VETERAN MEMORIAL BLVD # 202
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City | METAIRIE
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State | LA
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Zip | 70002-5636
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Country | US
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Telephone | 225-205-7060
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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