MEDICARE: SANDY PHAM-VANG OD

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	3056	MN

General Provider Information

NPI Number	:	1689607780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY PHAM-VANG OD

Provider Business Mailing Address
First Line	:	7074 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1370
Country	:	US
Telephone Number	:	763-316-4193
Fax Number	:	763-363-0002

Provider Business Practice Location Address
First Line	:	7074 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1370
Country	:	US
Telephone Number	:	763-316-4193
Fax Number	:	763-363-0002

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/20/2024

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