Provider Demographics
NPI:1073775383
Name:OPTICAL CONCEPTS
Entity Type:Organization
Organization Name:OPTICAL CONCEPTS
Other - Org Name:OPTICAL CONCEPTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOANG-QUAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-557-5101
Mailing Address - Street 1:5975 S COOPER ST STE 121
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-4400
Mailing Address - Country:US
Mailing Address - Phone:817-557-5101
Mailing Address - Fax:817-557-0230
Practice Address - Street 1:5975 S COOPER ST STE 121
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-4400
Practice Address - Country:US
Practice Address - Phone:817-557-5101
Practice Address - Fax:817-557-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06631TG302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV05116Medicare UPIN