Thao Pham-Diaz, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

11729T Issued in CA

Practice address

6160 Arlington Ave Ste C1
Riverside, CA 92504-1943

Phone

(951) 977-8635

NPI assigned

Mar 1, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Thao Pham Professional name

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1346378114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6160 ARLINGTON AVE STE C1",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925041943",
            "telephone_number": "951-977-8635",
            "fax_number": "951-977-8637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6160 ARLINGTON AVE STE C1",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925041943",
            "telephone_number": "951-977-8635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM-DIAZ",
        "first_name": "THAO",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11729",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11729T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THAO",
            "last_name": "PHAM",
            "credential": "O.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• PH Wellness, Inc.
• PH Wellness, Inc.
• PH Wellness, Inc.
• Jasmine Phaguda, MD
• Tiffany Phalavisay, RRT
• Bryant Pham, PHARM D
• Cam Thach Pham, PHARMD
• Chris C Pham, PA
• Donna Pham
• Donna P Pham, PHARMD

• Optometrist in Riverside, CA
• Providers in Riverside, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.