Tan-Long Pham, MS, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC4085 Issued in FL

Practice address

316 Del Prado Blvd S
Cape Coral, FL 33990-1710

Phone

(239) 226-2640

Fax

(239) 458-0178

NPI assigned

Nov 3, 2005

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 identifiers 3

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

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Health Centers of Southwest Florida IncGroup PAC ID 3173432085, 37 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• Family Health Centers of Southwest Florida Inc

  • Federally Qualified Health Center (FQHC)
  • Fort Myers, FL
  • NPI 1326090390
  Medicare reassignment Care Compare group
• Family Health Centers of Southwest Florida, Inc.

  • Federally Qualified Health Center (FQHC)
  • Cape Coral, FL
  • NPI 1417377813
  NPD

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1699766949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 919771",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328919771",
            "telephone_number": "239-278-3600",
            "fax_number": "239-226-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 DEL PRADO BLVD S",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339901710",
            "telephone_number": "239-226-2640",
            "fax_number": "239-458-0178"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3415 Lee Blvd",
            "address_purpose": "LOCATION",
            "city": "Lehigh Acres",
            "state": "FL",
            "postal_code": "339711576",
            "country_code": "US",
            "telephone_number": "239-226-2640",
            "fax_number": "239-458-0178",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "TAN-LONG",
        "name_prefix": "Dr.",
        "credential": "MS, OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC4085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621103800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "U7179W",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL LICENSE",
            "identifier": "OPC 4085",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erica Petithomme
• Kathie-Lee Petsch, CCC-SLP
• Nathan Samuel Pettit, MS, LMHC, MCAP
• Gabrielle Pfeffer
• Ngoc Han Thi Pham, DPM
• Thomas S Pham, MD
• Nhi Thi-Hong Phan, MD
• Clarke Andrew Philips, PT, MHS
• Phillip Kraver DMD, PLLC
• David Alexander Phillips, DO

• Optometrist in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.