Provider Demographics
NPI:1386658433
Name:PHAM, CUONG T (OD)
Entity Type:Individual
Prefix:
First Name:CUONG
Middle Name:T
Last Name:PHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 SUNNINGDALE
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5151
Mailing Address - Country:US
Mailing Address - Phone:972-989-9772
Mailing Address - Fax:
Practice Address - Street 1:13331 PRESTON RD
Practice Address - Street 2:2228
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-1130
Practice Address - Country:US
Practice Address - Phone:469-374-0782
Practice Address - Fax:469-374-0791
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6461T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management