Individual provider Active NPI

Thien Chu Pham, OD

  • Optometrist
  • Hollister, CA
National Provider Identifier
1699745349
Registry record updated Mar 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
12347T Issued in CA
Practice address
956 San Benito St
Ste. a
Hollister, CA 95023-4877
Phone
(831) 637-2020
Fax
(831) 637-6138
NPI assigned
Jan 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 12347T CA Primary

Addresses

Primary practice location

956 San Benito St
Ste. a
Hollister, CA 95023-4877

Mailing address

956 San Benito St
Ste. a
Hollister, CA 95023-4877
Phone (831) 637-2020

Other identifiers 2

IdentifierTypeStateIssuer
SD0123470MedicaidCA
SD0123470OtherCABLUE SHIELD/BLUE CROSS

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20040416001495 CA Practitioner - Optometry 4385639582 Practice locations: Hollister, CA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

956 San Benito St
Ste. a
Hollister, CA 95023-4877

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12347TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eyemd on Cass a Professional Corporation Optometrist Past Accepting new patients

Organizations & group practices 1

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": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363651200000",
    "number": "1699745349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "956 SAN BENITO ST",
            "address_2": "STE. A",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950234877",
            "telephone_number": "831-637-2020",
            "fax_number": "831-637-6138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "956 SAN BENITO ST",
            "address_2": "STE. A",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950234877",
            "telephone_number": "831-637-2020",
            "fax_number": "831-637-6138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "THIEN",
        "middle_name": "CHU",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2013-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12347T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0123470",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD/BLUE CROSS",
            "identifier": "SD0123470",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollister, CA

Sources for this page

Verify at the official NPI Registry.