Provider Demographics
NPI:1235119108
Name:PHAM, NICOLE ANH (O D)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANH
Last Name:PHAM
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5366 BEAUMONT CANYON DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2432
Mailing Address - Country:US
Mailing Address - Phone:408-223-6853
Mailing Address - Fax:408-223-6853
Practice Address - Street 1:1301 E CALAVERAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5543
Practice Address - Country:US
Practice Address - Phone:408-263-2040
Practice Address - Fax:408-946-2020
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10549T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist