Provider Demographics
NPI:1851549836
Name:PHAM, THOMAS DUY (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DUY
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 1:3025 W CHRISTOFFERSEN PKWY
Mailing Address - Street 2:APT# K302
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-8909
Mailing Address - Country:US
Mailing Address - Phone:503-939-0107
Mailing Address - Fax:
Practice Address - Street 1:2111 FULKERTH RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-9515
Practice Address - Country:US
Practice Address - Phone:503-939-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13597152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist