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NPI Code Detail

MEDICARE: TUANH PHAN LA O.D.

MEDICARE: TUANH PHAN LA 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
1152W00000XOptometrist7565TTX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1TXB148627OTHERTXMEDICARE INDIVIDUAL PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538472683
Entity Type Code : Individual
Provider Name (Legal Business Name) : TUANH PHAN LA O.D.
Provider Business Mailing Address
First Line : 423 ORCHARD HILL DR
Second Line :
City : CEDAR HILL
State : TX
Zip : 75104-5418
Country : US
Telephone Number : 214-727-6542
Fax Number :
Provider Business Practice Location Address
First Line : 9500 CLIFFORD ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76108-4403
Country : US
Telephone Number : 817-367-7100
Fax Number : 817-367-7102
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2010
Last Update Date : 09/28/2012

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Directions to “ TUANH PHAN LA O.D.” Practice Location

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