Provider Demographics
NPI:1184877748
Name:DOUANGPHILA, MANILOM JULIE (OD)
Entity type:Individual
Prefix:DR
First Name:MANILOM
Middle Name:JULIE
Last Name:DOUANGPHILA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:806 S ALLEN HEIGHTS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1875
Mailing Address - Country:US
Mailing Address - Phone:214-383-7600
Mailing Address - Fax:214-383-7652
Practice Address - Street 1:806 S ALLEN HEIGHTS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-1875
Practice Address - Country:US
Practice Address - Phone:214-383-7600
Practice Address - Fax:214-383-7652
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7332T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L6549Medicare PIN