NPIMap

Organization Active NPI

Dr. Jaclyn Phan & Associates

  • Clinic/Center
  • Bothell, WA
National Provider Identifier
1437330123
Registry record updated Nov 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
3357 Issued in WA
Legal business name
DR. JACLYN PHAN & ASSOCIATES
Practice address
1912 201St PL SE
Suite 204
Bothell, WA 98012-8570
Phone
(425) 485-6812
Fax
(425) 485-6813
NPI assigned
Nov 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2007

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

Authorized official

Name
Dr. Jaclyn T Phan, O.D.
Title
President
Phone
(425) 485-6812

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 3357 WA Primary

Addresses

Primary practice location

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

Mailing address

1912 201St PL SE
Suite 204
Bothell, WA 98012-8570
Phone (425) 485-6812

Other identifiers 1

IdentifierTypeStateIssuer
2033652MedicaidWA

Other names 1

  • Comfort Vision Doing business as

National Provider Directory

National Provider Directory

Locations

1912 201st Pl SE
Ste 204
Bothell, WA 98012
Phone (425) 485-6812

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195603200000",
    "number": "1437330123",
    "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",
            "fax_number": "425-485-6813"
        },
        {
            "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",
            "fax_number": "425-485-6813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. JACLYN PHAN & ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-21",
        "last_updated": "2007-11-21",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-485-6812",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "3357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2033652",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comfort Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bothell, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.