Basic Information
| Provider Information | |||||||||
| NPI: | 1730565292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | TOMMY | ||||||||
| MiddleName: | TAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3848 VETERAN MEMORIAL BLVD | ||||||||
| Address2: | # 202 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700025636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252057060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3848 VETERANS MEMORIAL BLVD | ||||||||
| Address2: | # 202 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700025671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252057060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2015 | ||||||||
| LastUpdateDate: | 08/07/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | Y | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.