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General NPI Number Information
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NPI Number | 1700679065
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Entity Type | Individual
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Provider Name | MEGAN THU PHU OD
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Gender | Female
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 3908 FAR WEST BLVD
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City | AUSTIN
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State | TX
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Zip | 78731-2994
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Country | US
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Telephone | 512-343-0432
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E 4TH ST STE 440
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City | ALTON
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State | IL
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Zip | 62002-6206
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Country | US
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Telephone | 618-462-9818
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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 | 11376
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License Number State | TX
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