Provider Demographics
NPI:1376685966
Name:PHAM, TERESA DIEMTU (OD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:DIEMTU
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:14465 POTOMAC MILLS RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6807
Practice Address - Country:US
Practice Address - Phone:703-494-6184
Practice Address - Fax:703-499-9744
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2024-01-19
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Provider Licenses
StateLicense IDTaxonomies
CAOPT 12954TPA152W00000X
WI3640-35152W00000X
FLTPOP23152W00000X
NY009190152W00000X
VA0618002984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist