Provider Demographics
NPI:1558598946
Name:PHAM, VAN HOANG (OD)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:HOANG
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 1:2801 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3587
Mailing Address - Country:US
Mailing Address - Phone:925-933-2600
Mailing Address - Fax:925-933-2716
Practice Address - Street 1:2801 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3587
Practice Address - Country:US
Practice Address - Phone:925-933-2600
Practice Address - Fax:925-933-2716
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13701152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist