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General NPI Number Information
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NPI Number | 1437442266
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Entity Type | Organization
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Legal Business Name | KP EYECARE, PLLC
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 18700 LIMESTONE COMMERCIAL DR
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-6544
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Country | US
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Telephone | 512-251-8282
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Fax |
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Provider Business Mailing Address
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Address Line | 18700 LIMESTONE COMMERCIAL DR
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-6544
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Country | US
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Telephone | 512-251-8282
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KELLY PHUONG PHAN
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Credential | OD
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Telephone | 512-251-8282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 7380T
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License Number State | TX
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