Molly Sue Phan, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3100T Issued in OR

Practice address

3710 SW US Veterans Hospital Rd
Portland, OR 97239-2964

Phone

(503) 220-8262

NPI assigned

Dec 10, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1134172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1124003397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11670 SW BLAKENEY",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "97008",
            "telephone_number": "503-330-4480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3710 SW US VETERANS HOSPITAL RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972392964",
            "telephone_number": "503-220-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "MOLLY",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-10",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00004038",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3100T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francis Thanh Phan, M.D.
• Hachau C Phan, AGACNP-BC
• Helen Phan
• Kim Phan, RDH
• Michael Phan, PHARMD
• Mona Tuong-Khanh Phan
• Nhu Y Sarah Phan, RN
• Phuong T Phan, PHARMD
• Steven T Phan, MD
• Tran Phan

• Optometrist in Portland, OR
• Providers in Portland, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.