Organization
OPTOMETRICA O D P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHONG MICHAEL PHAM OD (PRESIDENT / OWNER)
(239) 560-6917
Entity
Organization
Contact information
Practice address
1571 PERIWINKLE WAY, SANIBEL, FL 33957-4513
(239) 560-6917
(239) 415-7341
Mailing address
6747 WILLOW LAKE CIR, FORT MYERS, FL 33966-1253
(239) 560-6917
(239) 415-7341
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC3502
FL
Other
Enumeration date
08/03/2012
Last updated
10/01/2012
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