Jennifer T. Pha M, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD00004040 Issued in WA

Practice address

17028 41St PL W
Lynnwood, WA 98037-6969

Phone

(425) 787-0943

Fax

(425) 787-0943

NPI assigned

Nov 30, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164599486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17028 41ST PL W",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980376969",
            "telephone_number": "425-787-0943",
            "fax_number": "425-787-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17028 41ST PL W",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980376969",
            "telephone_number": "425-787-0943",
            "fax_number": "425-787-0943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHA M",
        "first_name": "JENNIFER",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00004040",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT  12971  TPA",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE PROVIDER NUMBER",
            "identifier": "4615PH",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE PROVIDER NUMBER",
            "identifier": "2023PH",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Scott Petitte
• Ellinor Petri Smith, PT
• Robert W Peyton, DDS
• John R Pfeifer, O.D.
• Mark J. Pfleger, M.D.
• Pham, Anwar PLLC
• Thuy-Ha Pham, RPH
• Daniel V. Phan, M.D.
• Phillips Rehab and Performance
• Benjamin Pierce

• Optometrist in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.