Dr Julie Phan OD Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

14612TLG Issued in CA

Legal business name

DR JULIE PHAN OD INC

Practice address

1055 Harriman PL
San Bernardino, CA 92408-4203

Phone

(909) 799-3130

NPI assigned

Dec 23, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Julie Phan, O.D.NPI 1487092813

Title

Optometrist

Phone

(909) 799-3130

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Julie Phan, O.D.

  • Optometrist
  • San Bernardino, CA
  • NPI 1487092813
  Medicare reassignment Care Compare group NPD Authorized official
• Herrick Duong, OD

  • Optometrist
  • San Diego, CA
  • NPI 1255959359
  Medicare reassignment Care Compare group NPD
• Toan A Nguyen, O.D.

  • Optometrist
  • San Marino, CA
  • NPI 1609122308
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1482451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482451200000",
    "number": "1013452234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13250 DON JULIAN RD",
            "city": "LA PUENTE",
            "state": "CA",
            "postal_code": "917462239",
            "telephone_number": "626-382-9096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 HARRIMAN PL",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924084203",
            "telephone_number": "909-799-3130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR JULIE PHAN OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-23",
        "last_updated": "2016-12-23",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "909-799-3130",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14612TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.