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General NPI Number Information
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NPI Number | 1588176168
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Entity Type | Individual
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Provider Name | STACY TRANG PHUONG OD
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Gender | Female
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 717 N 98TH ST
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City | OMAHA
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State | NE
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Zip | 68114-2340
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Country | US
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Telephone | 402-399-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 3327 ALBERT RAINES AVE
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City | BELLEVUE
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State | NE
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Zip | 68123-1838
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1472
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License Number State | NE
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