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Individual
TUANH PHAN LA
Active
Individual
TUANH PHAN LA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7565T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
219435902
—
TX
01
—
TXB148627
MEDICARE INDIVIDUAL PTAN
TX
Enumeration date
07/19/2010
Last updated
09/28/2012
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