Provider Demographics
NPI:1477649895
Name:AN, SANG WON (OD)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:WON
Last Name:AN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2625 OLD DENTON RD
Mailing Address - Street 2:SUITE 548
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5125
Mailing Address - Country:US
Mailing Address - Phone:972-242-1652
Mailing Address - Fax:972-242-1694
Practice Address - Street 1:2625 OLD DENTON RD
Practice Address - Street 2:SUITE 548
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5125
Practice Address - Country:US
Practice Address - Phone:972-242-1652
Practice Address - Fax:972-242-1694
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7039152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F22957Medicare PIN