Provider Demographics
NPI:1821086273
Name:PHAM, LOC (OD)
Entity type:Individual
Prefix:DR
First Name:LOC
Middle Name:
Last Name:PHAM
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N MCKEMY AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2654
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-961-4605
Practice Address - Street 1:1901 W WARNER RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2634
Practice Address - Country:US
Practice Address - Phone:480-812-2010
Practice Address - Fax:480-812-1884
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-000995152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ164133Medicare PIN
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AZZ164131Medicare PIN
AZZ164132Medicare PIN
AZZ164135Medicare PIN
AZZ162076Medicare PIN