Provider Demographics
NPI:1881650877
Name:PHAM, THU (OD)
Entity Type:Individual
Prefix:DR
First Name:THU
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2008 LAKE HOWELL LN
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5202
Mailing Address - Country:US
Mailing Address - Phone:407-647-3937
Mailing Address - Fax:321-251-1734
Practice Address - Street 1:2008 LAKE HOWELL LN
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5202
Practice Address - Country:US
Practice Address - Phone:407-647-3937
Practice Address - Fax:321-356-3423
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3824152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist