Provider Demographics
NPI:1255693263
Name:PHAN, TAMMY LE (OD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:LE
Last Name:PHAN
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:KIM
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5044
Mailing Address - Country:US
Mailing Address - Phone:210-524-6591
Mailing Address - Fax:
Practice Address - Street 1:550 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5044
Practice Address - Country:US
Practice Address - Phone:210-524-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist