Provider Demographics
NPI:1316087141
Name:PHAM, DOAN-ANH THI (OD)
Entity type:Individual
Prefix:
First Name:DOAN-ANH
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DOAN-ANH
Other - Middle Name:THI
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:14171 NORTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-5013
Mailing Address - Country:US
Mailing Address - Phone:713-939-8586
Mailing Address - Fax:713-939-8896
Practice Address - Street 1:14171 NORTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-5013
Practice Address - Country:US
Practice Address - Phone:713-939-8586
Practice Address - Fax:713-939-8896
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5008T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU55551Medicare UPIN
8F6905Medicare PIN