Provider Demographics
NPI:1003420126
Name:PHAM, ANNA HOAI
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:HOAI
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14014 CONNER DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-8811
Mailing Address - Country:US
Mailing Address - Phone:512-767-8215
Mailing Address - Fax:
Practice Address - Street 1:120 EMPRESARIO DR STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-4012
Practice Address - Country:US
Practice Address - Phone:210-957-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10018152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist