Jenny Fan, OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

5093TG Issued in TX

Legal business name

JENNY FAN, OD PA

Practice address

708 E 15TH St
Suite a
Plano, TX 75074-5712

Phone

(972) 509-8555

NPI assigned

Jan 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. William Fan, O.D.NPI 1912991415

Title

Secretary

Phone

(972) 262-4391

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Fan, O.D.

  • Optometrist
  • Plano, TX
  • NPI 1912991415
  Medicare reassignment NPD Authorized official
• Jenny Fan, O.D.

  • Optometrist
  • Plano, TX
  • NPI 1669466348
  Medicare reassignment NPD

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715904000000",
    "number": "1275689804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 E 15TH ST",
            "address_2": "SUITE A",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750745712",
            "telephone_number": "972-509-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 E 15TH ST",
            "address_2": "SUITE A",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750745712",
            "telephone_number": "972-509-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNY FAN, OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A",
        "authorized_official_last_name": "FAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "972-262-4391",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "5093TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178744201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Erin Jenkins, LPC
• Kayla Jenkins, BCBA
• Lorraine M Jenkins
• Jennifer Orbegoso Attmore Mdpa
• Jennifer R Stalkup MD PA
• Anne Jensen-Smith, LPC
• James Dean Jensen, DDS, MS, PA
• Karen Jensen
• Kyle Wesley Jensen, D.C.
• Morgan Ellen Jensen, RDN

• Optometrist in Plano, TX
• Providers in Plano, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.