Provider Demographics
NPI:1649396748
Name:PHAM, ANDREW LONG (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LONG
Last Name:PHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:208 GREAT MALL DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-8040
Mailing Address - Country:US
Mailing Address - Phone:408-263-3000
Mailing Address - Fax:408-263-8277
Practice Address - Street 1:208 GREAT MALL DR
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-8040
Practice Address - Country:US
Practice Address - Phone:408-263-3000
Practice Address - Fax:408-263-8277
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11728T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU88748Medicare UPIN