Provider Demographics
NPI:1609325711
Name:PHAM, ANH TUAN (OD)
Entity Type:Individual
Prefix:MR
First Name:ANH
Middle Name:TUAN
Last Name:PHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ANH
Other - Middle Name:TUAN
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1040 FLYNN RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5092
Mailing Address - Country:US
Mailing Address - Phone:805-673-3930
Mailing Address - Fax:805-659-3217
Practice Address - Street 1:4279 TIERRA REJADA RD
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3775
Practice Address - Country:US
Practice Address - Phone:805-222-2323
Practice Address - Fax:805-222-2333
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT15202152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist