Provider Demographics
NPI:1073666517
Name:PHAM, CAMTHU MINH (OD)
Entity Type:Individual
Prefix:DR
First Name:CAMTHU
Middle Name:MINH
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 E KENWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3310
Mailing Address - Country:US
Mailing Address - Phone:414-287-0070
Mailing Address - Fax:
Practice Address - Street 1:600 N SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1815
Practice Address - Country:US
Practice Address - Phone:262-798-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist