Provider Demographics
NPI:1629173000
Name:DR NINH PHAM OD AND ASSOCIATES
Entity Type:Organization
Organization Name:DR NINH PHAM OD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NINH
Authorized Official - Middle Name:XUAN
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-542-9350
Mailing Address - Street 1:3919 FAIRMONT PKWY APT 220
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3063
Mailing Address - Country:US
Mailing Address - Phone:281-542-9350
Mailing Address - Fax:
Practice Address - Street 1:9025 SPENCER HWY
Practice Address - Street 2:DR. NINH PHAM'S OPTOMETRY OFFICE
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-3870
Practice Address - Country:US
Practice Address - Phone:281-542-9350
Practice Address - Fax:281-542-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6245TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV10174Medicare UPIN
TX00W922Medicare PIN