Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 6613 | TX |
NPI | 1003828914 |
---|---|
Provider Name | Dr. Tu Minh Pham |
First Address | Houston, TX 77086-3169 |
Second Address | Houston, TX 77086-3169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V04559 | (02) | TX |