Provider Demographics
NPI:1063405215
Name:PHAM, KATIE P (OD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:P
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12320 BARKER CYPRESS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-8325
Mailing Address - Country:US
Mailing Address - Phone:281-373-1020
Mailing Address - Fax:281-373-1695
Practice Address - Street 1:12320 BARKER CYPRESS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-8326
Practice Address - Country:US
Practice Address - Phone:281-373-1020
Practice Address - Fax:281-373-1695
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5747TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156339701Medicaid
TX156339701Medicaid
TX4532070001Medicare NSC