Matt T Pham, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

11384T Issued in CA

Practice address

8080 Parkway Dr
La Mesa, CA 91942-2104

Phone

(858) 245-5147

Fax

(619) 589-3023

NPI assigned

Jan 19, 2007

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

Other names 1

• Hoai T Pham Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1497808794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2218 RIVER RUN DR",
            "address_2": "#107",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921085877",
            "telephone_number": "858-245-5147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8080 PARKWAY DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919422104",
            "telephone_number": "858-245-5147",
            "fax_number": "619-589-3023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "MATT",
        "middle_name": "T",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11384T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "HOAI",
            "last_name": "PHAM",
            "middle_name": "T",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Meghan Cary Petrille
• Devid Petrus, PHARMD
• Nicole Marie Petruso, OTR
• Bao Pham, PHARM.D.
• Cindy Dang Pham, MPT
• Quynh Vo Bao Pham, DDS
• Thuy-Linh Pham
• Thanhtruc Hoang Phan, FNP-C
• Philip D Szold MD Inc
• Phillip Dickinson, M.D., a Professional Corporation

• Optometrist in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.