Provider Demographics
NPI:1457468308
Name:PHAM, JULIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 ALMOND CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-2815
Mailing Address - Country:US
Mailing Address - Phone:281-286-9086
Mailing Address - Fax:281-334-8848
Practice Address - Street 1:255 FM 518 RD
Practice Address - Street 2:SUITE A
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-3219
Practice Address - Country:US
Practice Address - Phone:281-334-8848
Practice Address - Fax:281-334-8849
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6098T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX919769OtherBLOCKVISION
TX14310OtherSPECTERA
U91517Medicare UPIN
00947TMedicare ID - Type Unspecified