MEDICARE: NGHIEM PHAM OD PA

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	T5152	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

General Provider Information

NPI Number	:	1669795159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NGHIEM PHAM OD PA

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	:	OWNER
Name	:	NGHIEM NGUYEN PHAM
Credential	:	O.D.
Telephone Number	:	713-522-7448

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	07/11/2014

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