Provider Demographics
NPI:1619472701
Name:PHAM, KEVIN VAN (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:VAN
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 1:6730 ATASCOCITA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-1994
Mailing Address - Country:US
Mailing Address - Phone:281-883-4774
Mailing Address - Fax:
Practice Address - Street 1:6730 ATASCOCITA RD STE 101
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-1994
Practice Address - Country:US
Practice Address - Phone:281-883-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist