Provider Demographics
NPI:1427159821
Name:BANG, PHI PHI (OD)
Entity type:Individual
Prefix:DR
First Name:PHI
Middle Name:PHI
Last Name:BANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15933 CLAYTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:1675 CUMBERLAND PKWY SE
Practice Address - Street 2:SUITE #103
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6359
Practice Address - Country:US
Practice Address - Phone:770-438-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2015152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52052995000OtherBLUE CROSS BLUE SHIELD
GA52052995000OtherBLUE CROSS BLUE SHIELD
GA41ZCFPBMedicare PIN