Provider Demographics
NPI:1528045077
Name:ANH-THU N. PHAN, OD, PC
Entity Type:Organization
Organization Name:ANH-THU N. PHAN, OD, PC
Other - Org Name:AP EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANH-THU
Authorized Official - Middle Name:N
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:571-236-6754
Mailing Address - Street 1:9665A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3739
Mailing Address - Country:US
Mailing Address - Phone:703-978-2020
Mailing Address - Fax:703-978-6454
Practice Address - Street 1:9665A MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3739
Practice Address - Country:US
Practice Address - Phone:703-978-2020
Practice Address - Fax:703-978-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010069700Medicaid
VADE1141OtherRAILROAD MEDICARE
DCG01445Medicare PIN
VA010069700Medicaid