Debbi K. Fan, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

12825T Issued in CA

Practice address

690 River Oaks Pkwy Ste 20
San Jose, CA 95134-3226

Phone

(408) 502-7636

NPI assigned

Jul 27, 2006

Last updated

Feb 4, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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 CA

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

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/ACJBDA/Endpoint/ACJBDA

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

• Jon Gordon Wada, O.D.

  • Optometrist
  • San Jose, CA
  • NPI 1881633501
  Medicare reassignment
• Elaine Chung OD Inc

  • Optometrist
  • San Jose, CA
  • NPI 1912630542
  NPD
• Jon G. Wada, O.D.

  • Optometrist
  • San Jose, CA
  • NPI 1902967516
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1558375592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 RIVER OAKS PKWY STE 20",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951343226",
            "telephone_number": "408-502-7636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 RIVER OAKS PKWY STE 20",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951343226",
            "telephone_number": "408-502-7636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "DEBBI",
        "middle_name": "K.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2022-02-04",
        "certification_date": "2021-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12825T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Matters Inc
• Family Medicine Associates of San Jose Inc
• Family Practice Medical Associates, Inc.
• Familycare Behavioral Services (FamilyCare Autism Services)
• Foroozan Famoori, MD
• Gavin George Fan, M.D.
• Lisa Fan, O.D.
• Nancy Fan, RD
• Vincent C Fan, MD, MBA, MA, FAAO
• Wen Fan, M.A.

• Optometrist in San Jose, CA
• Providers in San Jose, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; 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.