Jaclyn T Phan, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

3357 Issued in WA

Practice address

1912 201St PL SE
Suite 204
Bothell, WA 98012-8570

Phone

(425) 485-6812

NPI assigned

Jan 16, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blue Wave Eye Doctors Professional Limited Liability Company

  • Optometrist
  • Everett, WA
  • NPI 1053060475
  Medicare reassignment NPD
• Sea Family Eye Care, PLLC

  • Optometrist
  • Mercer Island, WA
  • NPI 1124459193
  Medicare reassignment NPD
• Tricia Phan OD LLC

  • Optometrist
  • Tacoma, WA
  • NPI 1255611034
  Medicare reassignment NPD
• Clear Sight Northwest, PS

  • Optometrist
  • Kent, WA
  • NPI 1740558642
  Medicare reassignment
• Blue Wave Eye Doctors Professional Limited Liability Company

  • Eyewear Supplier
  • Olympia, WA
  • NPI 1902608755
  NPD
• Dr. Mai X. Nguyen & Associates, PLLC

  • Optometrist
  • Issaquah, WA
  • NPI 1679851737
  NPD (past)
• North Seattle Vision Care PLLC

  • Optometrist
  • Bothell, WA
  • NPI 1982911335
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195776000000",
    "number": "1114078235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 201ST PL SE",
            "address_2": "SUITE 204",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980128570",
            "telephone_number": "425-485-6812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 201ST PL SE",
            "address_2": "SUITE 204",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980128570",
            "telephone_number": "425-485-6812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "JACLYN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "WA",
            "license": "3357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elisabeth Petras, DPT, PT
• Ruth Joy Pettibone, MA60443142
• Shawna Pfahl
• Pfizer, Inc
• Crystal Pham
• Rachel Leeann Phillips, LPN
• Physiotherapy Associates, Inc.
• Naudia Notadeen Pickens, M.D., M.P.H.
• Timothy Michael Pierson, RD
• Carolyne Pietz

• Corneal and Contact Management Optometrist in Bothell, WA
• Providers in Bothell, WA by specialty
• Corneal and Contact Management Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.