Niam Phan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

14181 Issued in CA

Practice address

44 Serramonte Ctr
Daly City, CA 94015-2345

Phone

(201) 572-4039

NPI assigned

Jun 22, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1508152281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 VIRGINIA AVE",
            "city": "WEST SACRAMENTO",
            "state": "CA",
            "postal_code": "956913901",
            "telephone_number": "209-380-8145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 SERRAMONTE CTR",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940152345",
            "telephone_number": "201-572-4039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4364 Town Center Blvd Ste 118",
            "address_purpose": "LOCATION",
            "city": "El Dorado Hills",
            "state": "CA",
            "postal_code": "957627127",
            "country_code": "US",
            "telephone_number": "916-292-9226",
            "fax_number": "916-292-9227",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 Peachtree Ct Ste 103H",
            "address_purpose": "LOCATION",
            "city": "Holbrook",
            "state": "NY",
            "postal_code": "117414616",
            "country_code": "US",
            "telephone_number": "201-572-4039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "NIAM",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-22",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "CA",
            "license": "14181",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ognjen Petras, M.D.
• Laurie Petronis, COUNSELOR
• Nancy A. Petty, OTR CHT
• Dominic Phan-Romero
• Jackie Phan, M.D.
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• Physicians Surgery Center
• Bethany Pianca, R.D.
• Pillars Physical Therapy Inc (Pillars Physical Therapy and Wellness Center)
• Ping H Chow MD Corporation

• Optometrist in Daly City, CA
• Providers in Daly City, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; 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.