Provider Demographics
NPI:1417338823
Name:PHAM, NHATHY (OD)
Entity Type:Individual
Prefix:DR
First Name:NHATHY
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4218 AUTUMN LEAVES DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1108
Mailing Address - Country:US
Mailing Address - Phone:407-929-5433
Mailing Address - Fax:
Practice Address - Street 1:28150 WILLET WAY
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543
Practice Address - Country:US
Practice Address - Phone:813-907-3126
Practice Address - Fax:813-907-2845
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 5059152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist