MEDICARE: DR. NGHIEM PHAM O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5152T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	30FF	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1043227853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGHIEM PHAM O.D.

Provider Business Mailing Address
First Line	:	3221 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-2901
Country	:	US
Telephone Number	:	713-522-7448
Fax Number	:	713-522-5286

Provider Business Practice Location Address
First Line	:	3221 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-2901
Country	:	US
Telephone Number	:	713-522-7448
Fax Number	:	713-522-5286

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	04/02/2014

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