Provider Demographics
NPI:1346312618
Name:PHAM, ELAINE H (OD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:H
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2470 GRAY FALLS DR.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077
Mailing Address - Country:US
Mailing Address - Phone:281-556-5353
Mailing Address - Fax:281-556-5349
Practice Address - Street 1:2677 WILCREST DR.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042
Practice Address - Country:US
Practice Address - Phone:713-977-1170
Practice Address - Fax:713-977-3327
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5968TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1849770-01Medicaid
TX1849770-02Medicaid
TX184977003Medicaid
TXTXB128937Medicare PIN
TXTXB128980Medicare PIN