Individual
NGA PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
419 HAWTHORN CTR, VERNON HILLS, IL 60061-1507
(847) 549-0197
Mailing address
11103 WEST AVE, SAN ANTONIO, TX 78213-1370
(210) 524-6663
(210) 524-6587
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Enumeration date
04/10/2008
Last updated
04/10/2008
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