Provider Demographics
NPI:1659686145
Name:PHAM, MAILYNN H (OD)
Entity Type:Individual
Prefix:
First Name:MAILYNN
Middle Name:H
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:101 SETTLERS TRACE BLVD
Mailing Address - Street 2:2221
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6052
Mailing Address - Country:US
Mailing Address - Phone:714-890-2608
Mailing Address - Fax:
Practice Address - Street 1:3505 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5130
Practice Address - Country:US
Practice Address - Phone:337-984-1488
Practice Address - Fax:337-981-8240
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA1591-624T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist