1629173000 NPI number — DR NINH PHAM OD AND ASSOCIATES

Table of content: (NPI 1629173000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629173000 NPI number — DR NINH PHAM OD AND ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR NINH PHAM OD AND ASSOCIATES
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:
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:
1629173000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3919 FAIRMONT PKWY APT 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77504-3063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-542-9350
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9025 SPENCER HWY
Provider Second Line Business Practice Location Address:
DR. NINH PHAM'S OPTOMETRY OFFICE
Provider Business Practice Location Address City Name:
LA PORTE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77571-3870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-542-9350
Provider Business Practice Location Address Fax Number:
281-542-9355
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHAM
Authorized Official First Name:
NINH
Authorized Official Middle Name:
XUAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-542-9350

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6245TG , 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)





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