Ly K Phan, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

7098TG Issued in TX

Practice address

3751 Matlock Rd Ste 115
Arlington, TX 76015-4342

Phone

(817) 375-9000

NPI assigned

Dec 11, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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": "1197331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397174400000",
    "number": "1154504371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3751 MATLOCK RD",
            "address_2": "STE. 115",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760154341",
            "telephone_number": "817-375-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3751 MATLOCK RD STE 115",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760154342",
            "telephone_number": "817-375-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "LY",
        "middle_name": "K",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-11",
        "last_updated": "2014-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7098TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Toan Pham
• Aaron Lan Phan, PHARM.D.
• Andrew Phan, D.D.S
• Christy Phan, PHARM D
• Khuong Dinh Phan, D.O.
• Paulina Phuong Phan, O.D.
• Tien Van Phan, PT, DPT
• Yen Phan, DO
• Pharmaceutical Development Group LLC
• Pharmacy Concepts LTD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2014; 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.