Provider Demographics
NPI:1497756571
Name:DOAN, PHILLIP T (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:T
Last Name:DOAN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:8710 GRAND MISSION BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5413
Mailing Address - Country:US
Mailing Address - Phone:281-603-1777
Mailing Address - Fax:
Practice Address - Street 1:8710 GRAND MISSION BLVD STE D
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-5413
Practice Address - Country:US
Practice Address - Phone:281-603-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5657TG152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX318787YVS7Medicare PIN