Provider Demographics
NPI:1194001511
Name:XUAN T. PHAM, O.D., LLC
Entity Type:Organization
Organization Name:XUAN T. PHAM, O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:504-831-3662
Mailing Address - Street 1:PO BOX 1673
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70004-1673
Mailing Address - Country:US
Mailing Address - Phone:504-831-3662
Mailing Address - Fax:504-831-8272
Practice Address - Street 1:3900 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5704
Practice Address - Country:US
Practice Address - Phone:504-831-3662
Practice Address - Fax:504-831-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1624-657T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty