Provider Demographics
NPI:1952388498
Name:PHAN, ANH-THU NGUYEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ANH-THU
Middle Name:NGUYEN
Last Name:PHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 JULE STAR DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3019
Mailing Address - Country:US
Mailing Address - Phone:571-236-6754
Mailing Address - Fax:
Practice Address - Street 1:5219 JULE STAR DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-3019
Practice Address - Country:US
Practice Address - Phone:571-236-6754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1868152W00000X
NYVUT006531152W00000X
PAOEG000576152W00000X
VA0618001309152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
7690540OtherAETNA PPO
139264OtherANTHEM BCBS, ALEXANDRIA
146954OtherANTHEM BCBS, MANASSAS
3577168OtherAETNA HMO, ALEXANDRIA
J785OtherCAREFIRST BCBS
VAP00272543OtherRAILROAD MEDICARE
2129999OtherMAMSI
7690540OtherAETNA PPO
U92624Medicare UPIN
DCG01445A01Medicare PIN