Provider Demographics
NPI:1619460250
Name:PHAN, HONG VAN THI (OD)
Entity Type:Individual
Prefix:DR
First Name:HONG VAN
Middle Name:THI
Last Name:PHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 VAN ST SE
Mailing Address - Street 2:APT 1113
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4681
Mailing Address - Country:US
Mailing Address - Phone:301-949-3960
Mailing Address - Fax:
Practice Address - Street 1:11160 VEIRS MILL RD SPC G1
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-2542
Practice Address - Country:US
Practice Address - Phone:301-949-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist