Individual provider Active NPI

Tiffany Phuong, OD

  • Optometrist
  • Lancaster, PA
National Provider Identifier
1053973263
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG003576 Issued in PA
Practice address
1635 Manheim Pike
Lancaster, PA 17601-3027
Phone
(717) 299-0925
NPI assigned
Jul 8, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG003576 PA Primary
Optometrist 152W00000X OB009474 PA

Addresses

Primary practice location

1635 Manheim Pike
Lancaster, PA 17601-3027

Mailing address

312 Laurel Ave
Aldan, PA 19018-4206
Phone (610) 203-3592

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241206002054 PA Practitioner - Optometry 5991231474 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Pennsylvania LLCGroup PAC ID 3971884883, 118 clinicians

Practice addresses (Care Compare)

125 S Antrim Way
Greencastle, PA 17225-1521
Phone (717) 597-4780

5012 Carlisle Pike
Mechanicsburg, PA 17050-2401
Phone (717) 763-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OB009474PAMDOptometrist
OEG003576PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Pennsylvania, LLC Optometrist CurrentSince Nov 26, 2024 Accepting new patients
Myeyedr Optometry of Pennsylvania, LLC Optometrist CurrentSince Nov 26, 2024 Accepting new patients

Locations

125 S Antrim Way
Greencastle, PA 17225
Phone (717) 597-4780

5012 Carlisle Pike
Mechanicsburg, PA 17050
Phone (717) 763-2020

2842 S Eagle Rd
Newtown, PA 18940
Phone (215) 579-1155

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1053973263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 LAUREL AVE",
            "city": "ALDAN",
            "state": "PA",
            "postal_code": "190184206",
            "telephone_number": "610-203-3592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 MANHEIM PIKE",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176013027",
            "telephone_number": "717-299-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHUONG",
        "first_name": "TIFFANY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-08",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003576",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OB009474",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, PA

Sources for this page

Verify at the official NPI Registry.