Provider Demographics
NPI:1679310114
Name:PHAN, THAO-NGUYEN (OD)
Entity type:Individual
Prefix:DR
First Name:THAO-NGUYEN
Middle Name:
Last Name:PHAN
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 CURPIN CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5781
Mailing Address - Country:US
Mailing Address - Phone:512-501-9711
Mailing Address - Fax:
Practice Address - Street 1:14634 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-7517
Practice Address - Country:US
Practice Address - Phone:281-741-7295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11236T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist