MEDICARE: DR. SANG WON AN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7039	TX

General Provider Information

NPI Number	:	1477649895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANG WON AN O.D.

Provider Business Mailing Address
First Line	:	2625 OLD DENTON RD
Second Line	:	SUITE 548
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5125
Country	:	US
Telephone Number	:	972-242-1652
Fax Number	:	972-242-1694

Provider Business Practice Location Address
First Line	:	2625 OLD DENTON RD
Second Line	:	SUITE 548
City	:	CARROLLTON
State	:	TX
Zip	:	75007-5125
Country	:	US
Telephone Number	:	972-242-1652
Fax Number	:	972-242-1694

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	03/10/2010

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