MEDICARE: DR. PHUONG PHAM 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	152W00000X	Optometrist	9796TG	TX

General Provider Information

NPI Number	:	1932753027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHUONG PHAM OD

Provider Business Mailing Address
First Line	:	UNIQUE VISION MANSFIELD
Second Line	:	1971 US HWY 287 N SUITE 105
City	:	MANSFIELD
State	:	TX
Zip	:	76063
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1971 U.S. 287 FRONTAGE RD STE 105, MANSFIELD, TX 76063
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7606
Country	:	US
Telephone Number	:	817-453-7591
Fax Number	:

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

Provider Enumeration Date	:	07/28/2019
Last Update Date	:	09/05/2020

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Directions to “ DR. PHUONG PHAM OD” Practice Location

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