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General NPI Number Information
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NPI Number | 1295969426
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Entity Type | Organization
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Legal Business Name | DR. LY PHAN & ASSOCIATES, P.C.
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Dates
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Enumeration Date | 05/01/2009
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 951 W BELT LINE RD SUITE A
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City | DESOTO
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State | TX
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Zip | 75115-3741
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Country | US
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Telephone | 972-274-6600
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Fax | 972-274-6603
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Provider Business Mailing Address
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Address Line | 409 QUAIL MEADOWS LN
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City | ARLINGTON
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State | TX
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Zip | 76002-3475
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Country | US
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Telephone | 972-274-6600
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Fax | 972-274-6603
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Authorized Official
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Title or Position | OWNER
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Name | LY KHAC PHAN
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Credential | O.D.
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Telephone | 972-274-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0798TG
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License Number State | TX
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