Provider Demographics
NPI:1326454869
Name:PHAM, HUY (OD)
Entity Type:Individual
Prefix:
First Name:HUY
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 N 27TH ST
Mailing Address - Street 2:WALMART VISION CENTER
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1190
Mailing Address - Country:US
Mailing Address - Phone:402-438-4386
Mailing Address - Fax:402-438-4393
Practice Address - Street 1:4700 N 27TH ST
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1190
Practice Address - Country:US
Practice Address - Phone:402-438-4386
Practice Address - Fax:402-438-4393
Is Sole Proprietor?:No
Enumeration Date:2014-07-04
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074096152W00000X
NE1424152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026652000Medicaid