Provider Demographics
NPI:1760453062
Name:PHAN, PAULINA PHUONG (OD)
Entity Type:Individual
Prefix:DR
First Name:PAULINA
Middle Name:PHUONG
Last Name:PHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4605 S COOPER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5827
Mailing Address - Country:US
Mailing Address - Phone:817-225-2213
Mailing Address - Fax:817-465-1778
Practice Address - Street 1:4605 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5827
Practice Address - Country:US
Practice Address - Phone:817-557-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5445TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU74320Medicare UPIN