Provider Demographics
NPI:1023318268
Name:PHAM, RIDO THI (OD)
Entity type:Individual
Prefix:
First Name:RIDO
Middle Name:THI
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 1:10322 KNOBOAK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2912
Mailing Address - Country:US
Mailing Address - Phone:713-702-8408
Mailing Address - Fax:
Practice Address - Street 1:27650 STATE HIGHWAY 249
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6518
Practice Address - Country:US
Practice Address - Phone:281-516-3937
Practice Address - Fax:281-516-3938
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7075T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist