Fortsmith Pham, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

6244TG Issued in TX

Practice address

5307 Colleyville Blvd Ste 100
Colleyville, TX 76034-5832

Phone

(817) 485-3300

NPI assigned

Nov 2, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Colleyville Eye CorporationGroup PAC ID 5294817185, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Colleyville Eye Corporation

  dba Simply Eyes

  • Optometrist
  • Colleyville, TX
  • NPI 1063546414
  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563321600000",
    "number": "1285712612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5307 COLLEYVILLE BLVD STE 100",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760345832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5307 COLLEYVILLE BLVD STE 100",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760345832",
            "telephone_number": "817-485-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "FORTSMITH",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2019-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6244TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peikar Orthodontics PLLC
• Pelican Medical Marketing LLC
• Sankar Pemmaraju, D.O.
• Kendall Peterson, M.S CCC-SLP
• Pham Pena PLLC
• Khanh Phan, D.D.S.
• Justus Varghese Philip, M.D.
• T'Airra Phillips
• Paulina Phommahaxay
• Physicians Data LLC

• Optometrist in Colleyville, TX
• Providers in Colleyville, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.