Kevin Cuong Pham, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3514K Issued in MN

Practice address

445 Minnesota St Ste 1500
Saint Paul, MN 55101-2269

Phone

(773) 588-3090

NPI assigned

Jun 20, 2017

Last updated

Dec 5, 2018By the provider in NPPES

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 1

Other names 1

• Cuong Huy Pham Professional name

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ovitsky Vision Care of Minnesota PC

  • Optometrist
  • Saint Paul, MN
  • NPI 1174010656
  Medicare reassignment NPD

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1831619998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 PIERCE ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047563",
            "telephone_number": "701-799-8063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 MINNESOTA ST STE 1500",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012269",
            "telephone_number": "773-588-3090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1360 University Ave W Ste 106",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551044092",
            "country_code": "US",
            "telephone_number": "701-799-9063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "KEVIN",
        "middle_name": "CUONG",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-20",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3514K",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3514",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CUONG",
            "last_name": "PHAM",
            "middle_name": "HUY",
            "credential": "OD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Andrew Pham
• Camelia Pham, DDS
• Charmiqua Audrelle Pham
• Dang Hong Pham
• Ignatius Duy-Anh Pham
• Phuong-Giang Thi Pham, DDS
• Susan H. Pham, DC, DAAPM, DACBN
• Therese Pham
• Truc Thanh Pham, RDH, DT
• Peter Phan

• Optometrist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.