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General NPI Number Information
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NPI Number | 1952388498
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Entity Type | Individual
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Provider Name | ANH-THU NGUYEN PHAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 5219 JULE STAR DR
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City | CENTREVILLE
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State | VA
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Zip | 20120-3019
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Country | US
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Telephone | 571-236-6754
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Fax |
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Provider Business Mailing Address
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Address Line | 5219 JULE STAR DR
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City | CENTREVILLE
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State | VA
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Zip | 20120-3019
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Country | US
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Telephone | 571-236-6754
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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 | TA1868
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | VUT006531
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG000576
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001309
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 0618001309
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 0618001309
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License Number State | VA
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