Provider Demographics
NPI:1033193321
Name:ANDRUS, LE PHAN (OD)
Entity type:Individual
Prefix:DR
First Name:LE
Middle Name:PHAN
Last Name:ANDRUS
Suffix:
Gender:
Credentials:OD
Other - Prefix:DR
Other - First Name:LE
Other - Middle Name:HOANG MY
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PSC 2 BOX 9867
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09012-0099
Mailing Address - Country:US
Mailing Address - Phone:206-755-1655
Mailing Address - Fax:
Practice Address - Street 1:LRMC
Practice Address - Street 2:CMR 402
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180-0402
Practice Address - Country:US
Practice Address - Phone:206-755-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2109152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist