Provider Demographics
NPI:1750468112
Name:PHAM, TRAM LE (OD)
Entity Type:Individual
Prefix:DR
First Name:TRAM
Middle Name:LE
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7295 FORSUM RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-1903
Mailing Address - Country:US
Mailing Address - Phone:408-892-0319
Mailing Address - Fax:
Practice Address - Street 1:265 MERIDIAN AVE
Practice Address - Street 2:STE 6
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2906
Practice Address - Country:US
Practice Address - Phone:408-995-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11732 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA1732OtherEYEMED VISION
CA13769OtherMEDICAL EYE SERVICES
CA16257OtherSPECTERA VISION
CA1608836OtherCLARITY VISION
CA50620OtherSAFEGUARD VISION
CASD0117320Medicaid
CASD0117321Medicaid
CASD0117320Medicare ID - Type Unspecified
CASD0117321Medicaid