Anh-Thu N. Phan, OD, PC
Organization Active NPI Optometrist · Fairfax, VA
NPI 1528045077 · NPPES record last updated Feb 25, 2015
Key facts
- NPI
- 1528045077
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- ANH-THU N. PHAN, OD, PC
- Practice address
- 9665A Main St
Fairfax, VA 22031-3739 - Phone
- (703) 978-2020
- Fax
- (703) 978-6454
- NPI assigned
- Dec 27, 2005
- Organization subpart
- No
Authorized official
- Name
- Dr. Anh-Thu N. Phan, O.D.
- Title
- President/Director
- Phone
- (571) 236-6754
Practitioners 1
-
Anh-Thu Nguyen Phan, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040329001258 | DC | Part B Supplier - Clinic/Group Practice | 8426940875 |
Receives reassigned benefits from 1 practitioner Practice locations: Fairfax, VA |
National Provider Directory
Locations
3541 W Braddock Rd
Ste 204
Alexandria, VA 22302
Phone (703) 845-8200
9665A Main St
Fairfax, VA 22031
Phone (703) 222-8858
21030 Dulles Town Cir
Sterling, VA 20166
Phone (703) 421-5660
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes | ||
| Corneal and Contact Management Optometrist |
152WC0802X | |||
| Low Vision Rehabilitation Optometrist |
152WL0500X |
Addresses
Primary practice location
9665A Main St
Fairfax, VA 22031-3739
Mailing address
9665A Main St
Fairfax, VA 22031-3739
Phone (703) 978-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010069700 | Medicaid | VA | |
| DE1141 | Other | VA | RAILROAD MEDICARE |
Other names
- AP Eye Care
Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.