Provider Demographics
NPI:1437526803
Name:DR. KRYSTINA PHAM & ASSOCIATES
Entity Type:Organization
Organization Name:DR. KRYSTINA PHAM & ASSOCIATES
Other - Org Name:EYE CARE 4 TX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRYSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-552-4833
Mailing Address - Street 1:3613 HUTCH DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8965
Mailing Address - Country:US
Mailing Address - Phone:214-552-4833
Mailing Address - Fax:469-232-2010
Practice Address - Street 1:6185 RETAIL RD STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7807
Practice Address - Country:US
Practice Address - Phone:469-232-2010
Practice Address - Fax:469-232-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6326T152W00000X
TX8410TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX320184001Medicaid
TX320184002Medicaid