Provider Demographics
NPI:1598890337
Name:PHAM, QUANG
Entity type:Individual
Prefix:DR
First Name:QUANG
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:QUANG
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:16019 NACOGDOCHES RD STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1128
Mailing Address - Country:US
Mailing Address - Phone:210-659-2955
Mailing Address - Fax:210-787-3410
Practice Address - Street 1:16019 NACOGDOCHES RD STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1128
Practice Address - Country:US
Practice Address - Phone:210-659-2955
Practice Address - Fax:210-787-3410
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06290TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173675301Medicaid