1598190381 NPI number — KIM PHAM CO

Table of content: (NPI 1598190381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598190381 NPI number — KIM PHAM CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIM PHAM CO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SELECT VISION CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598190381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2271
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76063-0047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-793-2959
Provider Business Mailing Address Fax Number:
682-518-8017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1740 HIGHWAY 157 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76063-3921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-518-8018
Provider Business Practice Location Address Fax Number:
682-518-8017
Provider Enumeration Date:
09/11/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PHAM
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-793-2959

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  8070T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)