Provider Demographics
NPI:1366482697
Name:PHAM, HARRY H (OD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:H
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 1:6806 SPRINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-3217
Mailing Address - Country:US
Mailing Address - Phone:972-530-2900
Mailing Address - Fax:972-530-2599
Practice Address - Street 1:110 CEDAR SAGE
Practice Address - Street 2:SUITE C15
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040
Practice Address - Country:US
Practice Address - Phone:972-530-2900
Practice Address - Fax:972-530-2599
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX6462TG152W00000X, 152WC0802X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV08020Medicare UPIN
TX8F2179Medicare ID - Type UnspecifiedPROVIDER NUMBER