Provider Demographics
NPI:1295969426
Name:DR. LY PHAN & ASSOCIATES, P.C.
Entity type:Organization
Organization Name:DR. LY PHAN & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LY
Authorized Official - Middle Name:KHAC
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-274-6600
Mailing Address - Street 1:409 QUAIL MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3475
Mailing Address - Country:US
Mailing Address - Phone:972-274-6600
Mailing Address - Fax:972-274-6603
Practice Address - Street 1:951 W BELT LINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3741
Practice Address - Country:US
Practice Address - Phone:972-274-6600
Practice Address - Fax:972-274-6603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. LY PHAN & ASSOCIATES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-01
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0798TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty