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General NPI Number Information
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NPI Number | 1649121179
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Entity Type | Individual
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Provider Name | BRIAN PHAN OD
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Gender | Male
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 1211 MARICOPA HWY STE 101
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City | OJAI
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State | CA
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Zip | 93023-3165
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Country | US
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Telephone | 805-646-5109
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 STONEHENGE DR
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City | TUSTIN
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State | CA
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Zip | 92780-4724
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Country | US
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Telephone | 949-299-9771
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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 | 36164
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License Number State | CA
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