Provider Demographics
NPI:1043227853
Name:PHAM, NGHIEM (OD)
Entity Type:Individual
Prefix:DR
First Name:NGHIEM
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:NGHIEM
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3221 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-2901
Mailing Address - Country:US
Mailing Address - Phone:713-522-7448
Mailing Address - Fax:713-522-5286
Practice Address - Street 1:3221 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-2901
Practice Address - Country:US
Practice Address - Phone:713-522-7448
Practice Address - Fax:713-522-5286
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5152T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043227853Medicaid
TX30FFOtherBCBS