Provider Demographics
NPI:1043798994
Name:HUONG PHAM OPTOMETRY CORPORATION
Entity Type:Organization
Organization Name:HUONG PHAM OPTOMETRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HUONG
Authorized Official - Middle Name:T
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-265-2197
Mailing Address - Street 1:14251 EUCLID ST STE F101
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4957
Mailing Address - Country:US
Mailing Address - Phone:714-265-2197
Mailing Address - Fax:714-265-2411
Practice Address - Street 1:14251 EUCLID ST STE F101
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4957
Practice Address - Country:US
Practice Address - Phone:714-265-2197
Practice Address - Fax:714-265-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10462261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10462TMedicaid