Provider Demographics
NPI:1215183454
Name:TONY PHAN OD
Entity Type:Organization
Organization Name:TONY PHAN OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-695-5550
Mailing Address - Street 1:1887 WHITNEY MESA DR # 4484
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2069
Mailing Address - Country:US
Mailing Address - Phone:972-695-5550
Mailing Address - Fax:972-417-9690
Practice Address - Street 1:1927 E BELT LINE RD
Practice Address - Street 2:SUITE 166
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5821
Practice Address - Country:US
Practice Address - Phone:972-695-5550
Practice Address - Fax:972-417-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7275T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty