Provider Demographics
NPI:1487373320
Name:PHAM, BRYAN (OD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17911 OAKFIELD GLEN LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2176
Mailing Address - Country:US
Mailing Address - Phone:281-818-9912
Mailing Address - Fax:
Practice Address - Street 1:10615 FRY RD STE 500
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6978
Practice Address - Country:US
Practice Address - Phone:281-393-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10588T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist