Individual provider Active NPI

Quynh Nhu Pham, OD

  • Optometrist
  • Maitland, FL
National Provider Identifier
1679908370
Registry record updated Apr 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC 4906 Issued in FL
Practice address
2008 Lake Howell LN
Maitland, FL 32751-5202
Phone
(407) 647-3937
Fax
(321) 251-1734
NPI assigned
Sep 12, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8313 TX
Optometrist 152W00000X OPC 4906 FL Primary

Addresses

Primary practice location

2008 Lake Howell LN
Maitland, FL 32751-5202

Mailing address

2008 Lake Howell LN
Maitland, FL 32751-5202
Phone (407) 647-3937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20150310002312 FL Practitioner - Optometry 1153647136 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8313TXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Howell Eye Associates, LLC Optometrist CurrentSince Mar 23, 2020 Accepting new patients
Aeg Florida Professional PLLC Optometrist CurrentSince Sep 23, 2024 Accepting new patients
Gulf Coast Optometry, PA CurrentSince Nov 17, 2019 Accepting new patients
National Vision, Inc. Past Accepting new patients
Visionworks, Inc PastSince Dec 12, 2014 Accepting new patients
National Vision, Inc. Past Accepting new patients

Locations

706 W State Road 436
Altamonte Springs, FL 32714
Phone (407) 774-1318

2254 W International Speedway Blvd
Daytona Beach, FL 32114
Phone (386) 252-3639

4957 S Cleveland Ave
Fort Myers, FL 33907
Phone (239) 278-1217

104 W Vine St
Ste C
Kissimmee, FL 34741
Phone (407) 944-4240

3635 US Highway 98 N
Lakeland, FL 33809
Phone (863) 937-9045

2008 Lake Howell Ln
Maitland, FL 32751
Phone (407) 647-3937

100 N Plumosa St
Merritt Island, FL 32953
Phone (321) 455-2950

2411 SW College Rd
Ocala, FL 34471
Phone (352) 873-3937

9571 W Colonial Dr
Ocoee, FL 34761
Phone (407) 522-4705

901 Blanding Blvd
Ste 4
Orange Park, FL 32065
Phone (904) 562-1160

330 N Alafaya Trl
Orlando, FL 32828
Phone (407) 208-1027

3808 E Colonial Dr
Orlando, FL 32803
Phone (407) 894-7533

Networks

  • Freedom Health HMO Network

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1378944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587513600000",
    "number": "1679908370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 LAKE HOWELL LN",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515202",
            "telephone_number": "407-647-3937",
            "fax_number": "321-251-1734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 LAKE HOWELL LN",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327515202",
            "telephone_number": "407-647-3937",
            "fax_number": "321-251-1734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "QUYNH",
        "middle_name": "NHU",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-12",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8313",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 4906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

Verify at the official NPI Registry.