Ly K Phan, OD | |
3751 Matlock Rd Ste 115, Arlington, TX 76015-4342 | |
(817) 375-9000 | |
Not Available |
Full Name | Ly K Phan |
---|---|
Gender | Male |
Speciality | Optometrist |
Location | 3751 Matlock Rd Ste 115, Arlington, Texas |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1154504371 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 7098TG (Texas) | Primary |
Provider Name | Vision Palace Pc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1770830507 PECOS PAC ID: 4880844695 Enrollment ID: O20121031000588 |
Mailing Address | Practice Location Address |
---|---|
Ly K Phan, OD 3751 Matlock Rd, Ste. 115, Arlington, TX 76015-4341 Ph: (817) 375-9000 | Ly K Phan, OD 3751 Matlock Rd Ste 115, Arlington, TX 76015-4342 Ph: (817) 375-9000 |
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