Provider Demographics
NPI:1942559273
Name:GEMIE N PHAM, OD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GEMIE N PHAM, OD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEMIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-856-4592
Mailing Address - Street 1:11872 GARNET CIR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1210
Mailing Address - Country:US
Mailing Address - Phone:714-968-4269
Mailing Address - Fax:714-968-5352
Practice Address - Street 1:17099 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3601
Practice Address - Country:US
Practice Address - Phone:714-968-4269
Practice Address - Fax:714-968-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty