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General NPI Number Information
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NPI Number | 1942559273
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Entity Type | Organization
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Legal Business Name | GEMIE N PHAM, OD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 17099 BROOKHURST ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3601
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Country | US
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Telephone | 714-968-4269
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Fax | 714-968-5352
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Provider Business Mailing Address
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Address Line | 11872 GARNET CIR
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City | GARDEN GROVE
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State | CA
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Zip | 92845-1210
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Country | US
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Telephone | 714-968-4269
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Fax | 714-968-5352
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEMIE N PHAM
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Credential | O.D.
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Telephone | 714-856-4592
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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 | 13553
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License Number State | CA
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