Provider Demographics
NPI:1336719046
Name:PHAM, VINCENT MINH (OD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:MINH
Last Name:PHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 GREENBRIAR DR APT 208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-5235
Mailing Address - Country:US
Mailing Address - Phone:714-414-3665
Mailing Address - Fax:
Practice Address - Street 1:2200 SOUTHWEST FWY STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4786
Practice Address - Country:US
Practice Address - Phone:281-241-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX10236T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program