Tricia Phan OD LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60176880 Issued in WA

Legal business name

TRICIA PHAN OD LLC

Practice address

4051 Tacoma Mall Blvd
Tacoma, WA 98409-7287

Phone

(253) 476-2874

NPI assigned

Aug 24, 2011

Last updated

Aug 24, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tricia PhanNPI 1245334630

Title

Owner

Phone

(253) 476-2874

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tricia Phan, OD

  • Optometrist
  • Tacoma, WA
  • NPI 1245334630
  Medicare reassignment Authorized official
• Jaclyn T Phan, O.D.

  • Corneal and Contact Management Optometrist
  • Bothell, WA
  • NPI 1114078235
  Medicare reassignment NPD
• Craig Rouse

  • Optometrist
  • Lacey, WA
  • NPI 1720021330
  NPD (past)

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314144000000",
    "number": "1255611034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4051 TACOMA MALL BLVD",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984097287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4051 TACOMA MALL BLVD",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984097287",
            "telephone_number": "253-476-2874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRICIA PHAN OD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-24",
        "last_updated": "2011-08-24",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-476-2874"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60176880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlyn Trexler
• Laura Trezza, DPT
• Meaghan Nicole Trezza
• Lisa J Tribble
• Tribu Physical Therapy PLLC
• Sky Triece
• Gary Wayne Trimble, MSW
• Kenneth Louis Trimble
• Thuydung Thi Trinh, M.D.
• Lottie L Triplett-Fitts, MSW

• Optometrist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; 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.