Provider Demographics
NPI:1265677363
Name:PHAM, GEMIE N (OD)
Entity Type:Individual
Prefix:DR
First Name:GEMIE
Middle Name:N
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11872 GARNET CIR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1210
Mailing Address - Country:US
Mailing Address - Phone:714-856-4592
Mailing Address - Fax:
Practice Address - Street 1:17099 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3601
Practice Address - Country:US
Practice Address - Phone:714-968-4269
Practice Address - Fax:714-968-5352
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist