Provider Demographics
NPI:1972947463
Name:TRINH Q. PHAN, OD,PA
Entity Type:Organization
Organization Name:TRINH Q. PHAN, OD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRINH
Authorized Official - Middle Name:Q
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-319-6883
Mailing Address - Street 1:7401 SAMUELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-6166
Mailing Address - Country:US
Mailing Address - Phone:214-319-6883
Mailing Address - Fax:214-319-6887
Practice Address - Street 1:7401 SAMUELL BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-6166
Practice Address - Country:US
Practice Address - Phone:214-319-6883
Practice Address - Fax:214-319-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05495T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty