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General NPI Number Information
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NPI Number | 1932753027
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Entity Type | Individual
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Provider Name | PHUONG PHAM OD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2019
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Last Update Date | 09/05/2020
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Provider Practice Location Address
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Address Line | 1971 U.S. 287 FRONTAGE RD STE 105, MANSFIELD, TX 76063
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City | MANSFIELD
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State | TX
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Zip | 76063-7606
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Country | US
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Telephone | 817-453-7591
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Fax |
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Provider Business Mailing Address
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Address Line | UNIQUE VISION MANSFIELD 1971 US HWY 287 N SUITE 105
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City | MANSFIELD
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State | TX
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Zip | 76063
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Country | US
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Telephone |
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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 | 9796TG
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License Number State | TX
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