1326454869 NPI number — HUY PHAM O.D.

Table of content: HUY PHAM O.D. (NPI 1326454869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326454869 NPI number — HUY PHAM O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHAM
Provider First Name:
HUY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1326454869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 N 27TH ST
Provider Second Line Business Mailing Address:
WALMART VISION CENTER
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68521-1190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-438-4386
Provider Business Mailing Address Fax Number:
402-438-4393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 N 27TH ST
Provider Second Line Business Practice Location Address:
WALMART VISION CENTER
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68521-1190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-438-4386
Provider Business Practice Location Address Fax Number:
402-438-4393
Provider Enumeration Date:
07/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  074096 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 1424 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10026652000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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