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Organization
WILLIAM FAN, OD PA
Active
Organization
WILLIAM FAN, OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLLIAM FAN O.D. (PRESIDENT)
(972) 262-4391
Entity
Organization
Contact information
Practice address
625 W DICKEY RD, GRAND PRAIRIE, TX 75051-3129
(972) 262-4391
(972) 264-6135
Mailing address
625 W DICKEY RD, GRAND PRAIRIE, TX 75051-3129
(972) 262-4391
(972) 264-6135
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4925TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112248401
—
TX
Enumeration date
02/17/2007
Last updated
03/23/2009
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