Individual
MEDI LEE PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1101 MELBOURNE RD STE 3002, HURST, TX 76053-6225
(817) 284-0798
Mailing address
900 LAKE CAROLYN PKWY APT 533, IRVING, TX 75039-4650
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
10072
TX
Other
Enumeration date
10/23/2020
Last updated
10/23/2020
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