Provider Demographics
NPI:1962184630
Name:PHAM, NGOCANH (OD)
Entity type:Individual
Prefix:
First Name:NGOCANH
Middle Name:
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 1:481 SUNDANCE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2080
Mailing Address - Country:US
Mailing Address - Phone:512-255-9995
Mailing Address - Fax:
Practice Address - Street 1:481 SUNDANCE PKWY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2080
Practice Address - Country:US
Practice Address - Phone:512-255-9995
Practice Address - Fax:512-255-9997
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10754T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist