Provider Demographics
NPI:1245801125
Name:PHAM, WENDY UYEN
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:UYEN
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BARTON RD APT 806
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5490
Mailing Address - Country:US
Mailing Address - Phone:714-386-2087
Mailing Address - Fax:
Practice Address - Street 1:1668 E 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3168
Practice Address - Country:US
Practice Address - Phone:951-845-4749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist