Dr Niam Phan OD an Optometry Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

License

14181 TLG Issued in CA

Legal business name

DR NIAM PHAN OD AN OPTOMETRY CORPORATION

Practice address

4364 Town Center Blvd Ste 118
El Dorado Hills, CA 95762-7127

Phone

(916) 292-9226

Fax

(916) 292-9227

NPI assigned

Feb 26, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Niam Phan, OD

Title

President

Phone

(209) 380-8145

Specialties & licenses 1

Addresses

Other names 1

• Folsom Lake Eye Care Optometric Former legal business name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nathaniel Charney, OD

  • Optometrist
  • Sacramento, CA
  • NPI 1205441656
  NPD (past)
• William Huang, OD

  • Optometrist
  • Roseville, CA
  • NPI 1699061051
  NPD (past)

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

{
    "created_epoch": "1456444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1619337110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4364 TOWN CENTER BLVD",
            "address_2": "STE 118",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "95762",
            "telephone_number": "916-292-9226",
            "fax_number": "916-292-9227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4364 TOWN CENTER BLVD STE 118",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957627127",
            "telephone_number": "916-292-9226",
            "fax_number": "916-292-9227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR NIAM PHAN OD AN OPTOMETRY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "NIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-380-8145",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14181 TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Folsom Lake Eye Care Optometric",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Stephanie Amanda Dodge
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• Mariya Donskova
• Ashley Dordevic
• Sara Dreher
• Tyler Droppa
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• Ladonna Marie Drury-Klein, RDA
• Leandra Duarte

• Optometrist in El Dorado Hills, CA
• Providers in El Dorado Hills, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.