Provider Demographics
NPI:1033253703
Name:ANTHONY T. PHAM, O.D., P.C.
Entity Type:Organization
Organization Name:ANTHONY T. PHAM, O.D., P.C.
Other - Org Name:TINKER EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:TRUNG
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-455-2587
Mailing Address - Street 1:3360 N AVE BLDG 685
Mailing Address - Street 2:
Mailing Address - City:TINKER AFB
Mailing Address - State:OK
Mailing Address - Zip Code:73145-9028
Mailing Address - Country:US
Mailing Address - Phone:405-455-2587
Mailing Address - Fax:405-733-3124
Practice Address - Street 1:3360 N AVE BLDG 685
Practice Address - Street 2:
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73145-9028
Practice Address - Country:US
Practice Address - Phone:405-455-2587
Practice Address - Fax:405-733-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2280152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherEIN