MEDICARE: DR. ANH-THU NGUYEN PHAN 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	TA1868	MD
2	152W00000X	Optometrist	VUT006531	NY
3	152W00000X	Optometrist	OEG000576	PA
4	152W00000X	Optometrist	0618001309	VA
5	152WC0802X	Corneal and Contact Management Optometrist	0618001309	VA
6	152WL0500X	Low Vision Rehabilitation Optometrist	0618001309	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00272543	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	7690540	OTHER	AETNA PPO
2	139264	OTHER	ANTHEM BCBS, ALEXANDRIA
3	146954	OTHER	ANTHEM BCBS, MANASSAS
4	3577168	OTHER	AETNA HMO, ALEXANDRIA
5	J785	OTHER	CAREFIRST BCBS
7	2129999	OTHER	MAMSI

General Provider Information

NPI Number	:	1952388498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANH-THU NGUYEN PHAN O.D.

Provider Business Mailing Address
First Line	:	5219 JULE STAR DR
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20120-3019
Country	:	US
Telephone Number	:	571-236-6754
Fax Number	:

Provider Business Practice Location Address
First Line	:	5219 JULE STAR DR
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20120-3019
Country	:	US
Telephone Number	:	571-236-6754
Fax Number	:

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	02/15/2013

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Directions to “ DR. ANH-THU NGUYEN PHAN O.D.” Practice Location

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