Individual
JOHNNY PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
990 U.S. 287 FRONTAGE RD, #109, MANSFIELD, TX 76063
(817) 453-4682
(817) 453-4353
Mailing address
7552 JULIET LN, FORT WORTH, TX 76137-1096
(817) 899-5989
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
8720
TX
Other
Enumeration date
06/18/2015
Last updated
06/18/2015
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