Individual
BAO PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2053 WP BALL BLVD, SANFORD, FL 32771
(407) 322-9176
Mailing address
2053 WP BALL BLVD, SANFORD, FL 32771
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 4911
FL
Other
Enumeration date
06/20/2014
Last updated
06/20/2014
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