Provider Demographics
NPI:1497799662
Name:PHAM, NINH XUAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NINH
Middle Name:XUAN
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 1:10 MAJESTIC FALLS DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3510
Mailing Address - Country:US
Mailing Address - Phone:281-542-9350
Mailing Address - Fax:281-542-9355
Practice Address - Street 1:9025 SPENCER HWY
Practice Address - Street 2:DOCTOR OF OPTOMETRY
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-3870
Practice Address - Country:US
Practice Address - Phone:281-542-9350
Practice Address - Fax:281-542-9355
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6245TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F3754Medicare PIN
TXV10174Medicare UPIN