Provider Demographics
NPI:1588831754
Name:PHAM, LUKE HUY-VIET (RDO)
Entity Type:Individual
Prefix:MR
First Name:LUKE
Middle Name:HUY-VIET
Last Name:PHAM
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 NE 121ST AVE, STE N501
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-6202
Mailing Address - Country:US
Mailing Address - Phone:360-314-2826
Mailing Address - Fax:360-828-7338
Practice Address - Street 1:5305 NE 121ST AVE STE N501
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-6202
Practice Address - Country:US
Practice Address - Phone:360-314-2826
Practice Address - Fax:360-828-7338
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD 6055156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician