MEDICARE: DR. HOANG-QUAN DUONG 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	152WC0802X	Corneal and Contact Management Optometrist	6631TG	TX

General Provider Information

NPI Number	:	1063528370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOANG-QUAN DUONG PHAM O.D.

Provider Business Mailing Address
First Line	:	5975 S COOPER ST STE 121A
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4400
Country	:	US
Telephone Number	:	817-557-5101
Fax Number	:	817-557-0230

Provider Business Practice Location Address
First Line	:	5975 S COOPER ST STE 121A
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4400
Country	:	US
Telephone Number	:	817-557-5101
Fax Number	:	817-557-0230

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	02/22/2011

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