Provider Demographics
NPI:1275542425
Name:PHAN, HAOTAM THUY (OD)
Entity Type:Individual
Prefix:DR
First Name:HAOTAM
Middle Name:THUY
Last Name:PHAN
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 1:5846 NEW TERRITORY BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5948
Mailing Address - Country:US
Mailing Address - Phone:281-242-2946
Mailing Address - Fax:281-242-2947
Practice Address - Street 1:9555A SOUTH POST OAK RD.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096
Practice Address - Country:US
Practice Address - Phone:713-728-3937
Practice Address - Fax:713-728-3939
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6247TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169663501Medicaid
TXU99588Medicare UPIN
TX169663501Medicaid