Individual
ASHLEY PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11649 S 4000 W STE 200, SOUTH JORDAN, UT 84009-6048
(801) 253-3080
Mailing address
1530 S 700 E # A, SALT LAKE CITY, UT 84105-2102
(972) 333-3260
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
10237T
TX
152W00000X
Optometrist
Primary
12322408-9934
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
TX
Other
Enumeration date
05/03/2021
Last updated
01/04/2023
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