Provider Demographics
NPI:1750636064
Name:PHAM, PHONG (OD)
Entity Type:Individual
Prefix:
First Name:PHONG
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 UVALDE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10117 W GRAND PKWY S
Practice Address - Street 2:STE 101
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-8643
Practice Address - Country:US
Practice Address - Phone:832-781-2020
Practice Address - Fax:832-403-3151
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8050T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist