MEDICARE: DR. JULIE 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	6098T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	919769	OTHER	TX	BLOCKVISION
2	14310	OTHER	TX	SPECTERA

General Provider Information

NPI Number	:	1457468308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE PHAM O.D.

Provider Business Mailing Address
First Line	:	3311 ALMOND CREEK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-2815
Country	:	US
Telephone Number	:	281-286-9086
Fax Number	:	281-334-8848

Provider Business Practice Location Address
First Line	:	255 FM 518 RD
Second Line	:	SUITE A
City	:	KEMAH
State	:	TX
Zip	:	77565-3219
Country	:	US
Telephone Number	:	281-334-8848
Fax Number	:	281-334-8849

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JULIE PHAM O.D.” Practice Location

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