Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 6631TG | TX |
NPI | 1063528370 |
---|---|
Provider Name | Dr. Hoang-Quan Duong Pham |
First Address | Arlington, TX 76017-4400 |
Second Address | Arlington, TX 76017-4400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 22/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V05116 | (02) | TX |