Provider Demographics
NPI:1336719046
Name:PHAM, VINCENT MINH (OD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:MINH
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 1:2876 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-1145
Mailing Address - Country:US
Mailing Address - Phone:714-414-3665
Mailing Address - Fax:
Practice Address - Street 1:3155D SEDONA CT
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-6555
Practice Address - Country:US
Practice Address - Phone:909-698-9780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35001-TLG152W00000X
390200000X
TX10236T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program