Provider Demographics
NPI:1972608008
Name:PHAM, XUAN T (OD)
Entity type:Individual
Prefix:DR
First Name:XUAN
Middle Name:T
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 1:6176 BOLLINGER RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3000
Mailing Address - Country:US
Mailing Address - Phone:408-625-7466
Mailing Address - Fax:089-961-4194
Practice Address - Street 1:6176 BOLLINGER RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3000
Practice Address - Country:US
Practice Address - Phone:408-625-7466
Practice Address - Fax:408-996-1419
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11435T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0114350Medicaid
CASD0114350Medicare ID - Type Unspecified
CASD0114350Medicaid