NPIMap

Organization Active NPI

Eric Jan, O.D., LLC

  • Optometrist
  • Rockville, MD
National Provider Identifier
1487939690
Registry record updated Oct 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA2152 Issued in MD
Legal business name
ERIC JAN, O.D., LLC
Practice address
14008 Glen Mill Rd
Rockville, MD 20850-3427
Phone
(301) 996-7806
NPI assigned
Oct 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2011

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

Authorized official

Name
Eric Jan, ODNPI 1285862110
Title
Owner
Phone
(301) 996-7806

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X TA2152 MD Primary

Addresses

Primary practice location

14008 Glen Mill Rd
Rockville, MD 20850-3427

Mailing address

14008 Glen Mill Rd
Rockville, MD 20850-3427
Phone (301) 996-7806

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120110000690 MD Part B Supplier - Clinic/Group Practice 3173796547 Receives reassigned benefits from 3 practitioners
Practice locations: Elkridge, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1318982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318982400000",
    "number": "1487939690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14008 GLEN MILL RD",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503427",
            "telephone_number": "301-996-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14008 GLEN MILL RD",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503427",
            "telephone_number": "301-996-7806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIC JAN, O.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-19",
        "last_updated": "2011-10-19",
        "status": "A",
        "authorized_official_last_name": "JAN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-996-7806",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; 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.