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NPI Code Detail

MEDICARE: NICOLE NHU LAN PHAM

MEDICARE: NICOLE NHU LAN PHAM
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
1152W00000XOptometrist9959TTX

General Provider Information

NPI Number : 1104425834
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE NHU LAN PHAM
Provider Business Mailing Address
First Line : 3714 SKYLINE DR
Second Line :
City : MANVEL
State : TX
Zip : 77578-3243
Country : US
Telephone Number : 832-744-1837
Fax Number :
Provider Business Practice Location Address
First Line : 13615 BELLAIRE BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77083-1714
Country : US
Telephone Number : 281-933-3446
Fax Number : 281-933-6865
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2020
Last Update Date : 10/23/2020

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Directions to “ NICOLE NHU LAN PHAM ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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