Matthew Phan, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

8685 Issued in TX

Practice address

138 Gateway St
Beaumont, TX 77701-3706

Phone

(409) 835-2041

NPI assigned

Jun 9, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

Optometry

Education

Ohio State University - College of Optometry, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

2020 Eye Care PLLCGroup PAC ID 0345131181, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: broussard@tsogateway.com

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.

• 2020 Eye Care PLLC

  • Optometrist
  • Glenwood Springs, CO
  • NPI 1710061593
  Medicare reassignment Care Compare group NPD
• Ebf Eye Pro, LLC

  • Optometrist
  • The Woodlands, TX
  • NPI 1003246885
  NPD (past)
• Fadel Eye Pro, Inc.

  • Optometrist
  • Austin, TX
  • NPI 1174806640
  NPD (past)
• 2020 Eye Care PLLC

  • Optometrist
  • Carbondale, CO
  • NPI 1104584069
  NPD (past)

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

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1073993606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 GATEWAY ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777013706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 GATEWAY ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777013706",
            "telephone_number": "409-835-2041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9595 Six Pines Dr",
            "address_2": "Suite 1350A",
            "address_purpose": "LOCATION",
            "city": "The Woodlands",
            "state": "TX",
            "postal_code": "773801531",
            "country_code": "US",
            "telephone_number": "281-298-3755",
            "fax_number": "281-419-1317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "MATTHEW",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-09",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1073993606",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BROUSSARD@TSOGATEWAY.COM",
            "affiliation": "N",
            "address_1": "138 Gateway St",
            "city": "Beaumont",
            "state": "TX",
            "country_code": "US",
            "postal_code": "777013706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Catherine Van Pham, NP-C
• Ngoc-Thuy Thi Pham, PHARM.D.
• Tien Minh Pham, RPH
• Hoa Tuyet Phan, DDS
• Jackie Phan
• Pharmblue Texas LLC
• Phelan Dental Health Center PLLC
• Phelan EMS Inc
• Phelan Hearing Aid Inc
• Elizabeth L. Phelan, SPEECH PATHOLOGIST

• Optometrist in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.