Provider Demographics
NPI:1295393411
Name:PHAM, JONATHAN ANHDUY (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ANHDUY
Last Name:PHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6851 MATLOCK RD STE 111
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3519
Mailing Address - Country:US
Mailing Address - Phone:817-419-8871
Mailing Address - Fax:682-558-8229
Practice Address - Street 1:6851 MATLOCK RD STE 111
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-3519
Practice Address - Country:US
Practice Address - Phone:817-419-8871
Practice Address - Fax:682-558-8229
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9370T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist