Jenny Fan, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5903TG Issued in TX

Practice address

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

Phone

(972) 509-8555

Fax

(972) 509-8556

NPI assigned

Sep 8, 2005

Reactivated

Mar 30, 2006

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 TX

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

New England College of Optometry, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Med Southwest PLLC 234 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.

• Med Southwest, PLLC

  • Optometrist
  • Houston, TX
  • NPI 1609348739
  Medicare reassignment Care Compare group NPD
• Jenny Fan, OD PA

  • Optometrist
  • Plano, TX
  • NPI 1275689804
  Medicare reassignment NPD
• Med Southwest, PLLC

  • Optometrist
  • Texarkana, TX
  • NPI 1871059170
  Care Compare group NPD
• Med Southwest PLLC

  • Optometrist
  • Beaumont, TX
  • NPI 1558900373
  Care Compare group
• Med Southwest, PLLC

  • Optometrist
  • Hurst, TX
  • NPI 1366066466
  Care Compare group
• Med Southwest, PLLC

  • Optometrist
  • Longview, TX
  • NPI 1487290441
  Care Compare group
• Med Southwest, PLLC

  • Optometrist
  • San Marcos, TX
  • NPI 1730714114
  Care Compare group
• Med Southwest, PLLC

  • Optometrist
  • Bryan, TX
  • NPI 1871132761
  Care Compare group
• Med Southwest PLLC

  • Optometrist
  • El Dorado, AR
  • NPI 1124588405
  Care Compare group
• Med Southwest PLLC

  • Optometrist
  • Idabel, OK
  • NPI 1336605633
  Care Compare group
• Med Southwest, PLLC

  • Optometrist
  • Magnolia, AR
  • NPI 1093271397
  Care Compare group
• Med Southwest, PLLC

  • Optometrist
  • Tulsa, OK
  • NPI 1124798160
  Care Compare group

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1669466348",
    "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",
            "fax_number": "972-509-8556"
        },
        {
            "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",
            "fax_number": "972-509-8556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "JENNY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-08",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "deactivation_date": "2006-03-25",
        "reactivation_date": "2006-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "5903TG",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "TX",
            "license": "5903TG",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Tree Counseling, PLLC
• Modupe Mary Famodimu, PHARM.D
• Benjamin Fan, DDS
• Christopher Fan
• Ellen Fan, M.D.
• William Fan, O.D.
• Duan Yi Fang
• Vivian Fang
• Fannin County Hospital Authority
• Marah Farage, CCC-SLP

• All providers in Plano, TX
• 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; 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.