Provider Demographics
NPI:1679862395
Name:PHAM, SANG THANH (OD)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:THANH
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:THANH-SANG
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:9727 SPRING GREEN BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4141
Mailing Address - Country:US
Mailing Address - Phone:281-969-3931
Mailing Address - Fax:281-969-3932
Practice Address - Street 1:9727 SPRING GREEN BLVD STE 300
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-969-3931
Practice Address - Fax:281-969-3932
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7610TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1679862395OtherINDIVIDUAL NPI #
TX1386985976OtherGROUP NPI#
TX900940717OtherTAXID
TX1679862395OtherINDIVIDUAL NPI #
TX283010YRKQMedicare UPIN