Organization
PHAM-VANG OPTOMETRY LLC
Active
Other names
Eye Doc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANDY PHAM-VANG OD (CEO)
(763) 639-0103
Entity
Organization
Contact information
Practice address
7074 BROOKLYN BLVD, BROOKLYN CENTER, MN 55429-1370
(763) 316-4193
(763) 363-0002
Mailing address
7074 BROOKLYN BLVD, BROOKLYN CENTER, MN 55429-1370
(763) 316-4193
(763) 363-0002
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3056
MN
302F00000X
Exclusive Provider Organization
3056
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689607780
INDIVIDUAL NPI
MN
01
—
1831330679
GROUP NPI
MN
01
—
C05200
PTAN
MN
Enumeration date
03/06/2009
Last updated
11/08/2023
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