Provider Demographics
NPI:1134421035
Name:PHAM, XUAN THANH THI (OD)
Entity type:Individual
Prefix:DR
First Name:XUAN
Middle Name:THANH 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 1:6899 LAKEBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-2724
Mailing Address - Country:US
Mailing Address - Phone:602-206-1580
Mailing Address - Fax:
Practice Address - Street 1:5053 TUTTLE CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-1533
Practice Address - Country:US
Practice Address - Phone:614-760-5737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-27
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5970152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist