Provider Demographics
NPI:1033193321
Name:ANDRUS, LE PHAN (OD)
Entity Type:Individual
Prefix:
First Name:LE
Middle Name:PHAN
Last Name:ANDRUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LE
Other - Middle Name:HOANG MY
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PSC 9 BOX 2951
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09123-0030
Mailing Address - Country:US
Mailing Address - Phone:011491514-615-7387
Mailing Address - Fax:
Practice Address - Street 1:52 MDG
Practice Address - Street 2:UNIT 3690
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09126
Practice Address - Country:US
Practice Address - Phone:01149656-561-8425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2109152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist