Provider Demographics
NPI:1194342535
Name:PAN, PHOEBE YUANMEI (OD)
Entity type:Individual
Prefix:DR
First Name:PHOEBE
Middle Name:YUANMEI
Last Name:PAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:897 HERKIMER ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-6969
Mailing Address - Country:US
Mailing Address - Phone:832-488-5872
Mailing Address - Fax:
Practice Address - Street 1:128 MOTT ST STE 408
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5588
Practice Address - Country:US
Practice Address - Phone:212-732-0073
Practice Address - Fax:212-732-0191
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009159152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics