Individual
LISA PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
3905 N ANTHONY BLVD, FORT WAYNE, IN 46805-2233
(260) 432-8409
Mailing address
1530 SPENSER CV, FORT WAYNE, IN 46845-2365
(260) 579-2014
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18004252A
IN
Other
Enumeration date
06/27/2019
Last updated
12/30/2020
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