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General NPI Number Information
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NPI Number | 1679737712
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Entity Type | Individual
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Provider Name | TONY VAN PHAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 11/24/2018
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Provider Practice Location Address
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Address Line | 1927 E BELT LINE RD SUITE 166
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City | CARROLLTON
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State | TX
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Zip | 75006-5821
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Country | US
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Telephone | 972-695-5550
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Fax | 972-417-9690
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Provider Business Mailing Address
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Address Line | 1887 WHITNEY MESA DR # 4484
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City | HENDERSON
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State | NV
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Zip | 89014-2069
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Country | US
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Telephone | 972-695-5550
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Fax | 972-417-9690
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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 | TX7275TG
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License Number State | TX
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