Individual
DR. TYLER PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
147 LAKE ST, NEWBURGH, NY 12550-5263
(845) 563-8000
Mailing address
2570 ROUTE 9W STE 10, CORNWALL, NY 12518-1370
(845) 220-3100
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV008145
NY
Other
Enumeration date
06/11/2014
Last updated
05/28/2024
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