Provider Demographics
NPI:1578113981
Name:JOANN D. PHAM OD PA
Entity Type:Organization
Organization Name:JOANN D. PHAM OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:PHAM
Authorized Official - Last Name:PARISE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-373-3049
Mailing Address - Street 1:300 S AUSTRALIAN AVE UNIT 425
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5090
Mailing Address - Country:US
Mailing Address - Phone:561-373-3049
Mailing Address - Fax:
Practice Address - Street 1:318 E PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5016
Practice Address - Country:US
Practice Address - Phone:561-338-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty