Provider Demographics
NPI:1457664088
Name:PHAM, HUY TUAN (OD)
Entity Type:Individual
Prefix:
First Name:HUY
Middle Name:TUAN
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 1:5508 MANSION BLVD
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-1152
Mailing Address - Country:US
Mailing Address - Phone:856-486-0166
Mailing Address - Fax:
Practice Address - Street 1:55 PARSONAGE RD UNIT 501
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2495
Practice Address - Country:US
Practice Address - Phone:732-548-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-25
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00625700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist