Provider Demographics
NPI:1124180286
Name:PHU DOAN OD PA
Entity Type:Organization
Organization Name:PHU DOAN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHU
Authorized Official - Middle Name:T
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-568-8787
Mailing Address - Street 1:8300 W SAM HOUSTON PKWY S
Mailing Address - Street 2:STE 248
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5045
Mailing Address - Country:US
Mailing Address - Phone:281-568-8787
Mailing Address - Fax:281-568-8786
Practice Address - Street 1:8300 W SAM HOUSTON PKWY S
Practice Address - Street 2:STE 248
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5045
Practice Address - Country:US
Practice Address - Phone:281-568-8787
Practice Address - Fax:281-568-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2009-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A3509Medicare PIN