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Organization
TARGET INDEPENDENT DOCTOR OF OPTOMETRY
Active
Organization
TARGET INDEPENDENT DOCTOR OF OPTOMETRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY PHUONG PHAN O.D. (OPTOMETRIST)
(405) 761-2872
Entity
Organization
Contact information
Practice address
18700 LIMESTONE COMMERCIAL DR, PFLUGERVILLE, TX 78660-6544
(512) 990-1440
(512) 990-3691
Mailing address
3810 CONCORD DR, ROUND ROCK, TX 78665-1314
(405) 761-2872
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7380T
TX
Other
Enumeration date
07/07/2009
Last updated
07/07/2009
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