Provider Demographics
NPI:1871969097
Name:PHAM, ALINA (OD)
Entity type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11682 NEARING DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6746
Mailing Address - Country:US
Mailing Address - Phone:714-553-5306
Mailing Address - Fax:
Practice Address - Street 1:2800 N MAIN ST
Practice Address - Street 2:STE 104
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6607
Practice Address - Country:US
Practice Address - Phone:714-547-8194
Practice Address - Fax:714-547-5626
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist