Jenny Len Hong Phan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3819 Issued in TN

Practice address

623 S Cumberland St
Lebanon, TN 37087-5145

Phone

(615) 994-3989

NPI assigned

Sep 15, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

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

Specialty

Optometry

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Vision Center PAGroup PAC ID 6406929744, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• The Vision Center PA

  • Optometrist
  • Wiggins, MS
  • NPI 1790962637
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1694736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1669250262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1816 21ST AVE S",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372123706",
            "telephone_number": "228-313-2916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 S CUMBERLAND ST",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370875145",
            "telephone_number": "615-994-3989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "JENNY",
        "middle_name": "LEN HONG",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-15",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "1077",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "3819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mescha Petty, OTR/L
• James D Peyton, M.D.
• Todd Brownell Peyton, LPC
• Timothy Alan Pfountz, D.D.S.
• PH Wellness
• Pharmscript of TN LLC
• Sandra Phillips, PHD
• Phoenix Ambulatory Surgery Center LLC
• Physiotherapy Associates Inc
• Alton W Pickett, MD

• Optometrist in Lebanon, TN
• Providers in Lebanon, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.