Provider Demographics
NPI:1891075628
Name:PHAM, XUAN (OD)
Entity Type:Individual
Prefix:MS
First Name:XUAN
Middle Name:
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:PO BOX 1673
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70004-1673
Mailing Address - Country:US
Mailing Address - Phone:504-831-3662
Mailing Address - Fax:504-831-8272
Practice Address - Street 1:3900 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5704
Practice Address - Country:US
Practice Address - Phone:504-831-3662
Practice Address - Fax:504-831-8272
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1624-657T152W00000X
TX7758T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist