Provider Demographics
NPI:1003931411
Name:VICKY T. PHAM, O.D., P.C.
Entity Type:Organization
Organization Name:VICKY T. PHAM, O.D., P.C.
Other - Org Name:KINDRED EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:THI
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-292-9635
Mailing Address - Street 1:610 SAWDUST RD
Mailing Address - Street 2:OPTOMETRIST OFFICE
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2247
Mailing Address - Country:US
Mailing Address - Phone:281-292-9635
Mailing Address - Fax:281-292-9638
Practice Address - Street 1:610 SAWDUST RD
Practice Address - Street 2:OPTOMETRIST OFFICE
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2247
Practice Address - Country:US
Practice Address - Phone:281-292-9635
Practice Address - Fax:281-292-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6560152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty