Provider Demographics
NPI:1477785566
Name:PHAM, CANDACE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:MARIE
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 1:28404 HIGHWAY 290
Mailing Address - Street 2:SUITE G13
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5426
Mailing Address - Country:US
Mailing Address - Phone:281-817-4141
Mailing Address - Fax:
Practice Address - Street 1:28404 HIGHWAY 290
Practice Address - Street 2:SUITE G13
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5426
Practice Address - Country:US
Practice Address - Phone:281-817-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-22
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7426T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist