Provider Demographics
NPI:1730565292
Name:PHAM, TOMMY TAN
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:TAN
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 VETERAN MEMORIAL BLVD
Mailing Address - Street 2:# 202
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5636
Mailing Address - Country:US
Mailing Address - Phone:225-205-7060
Mailing Address - Fax:
Practice Address - Street 1:3848 VETERANS MEMORIAL BLVD
Practice Address - Street 2:# 202
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5671
Practice Address - Country:US
Practice Address - Phone:225-205-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician