Jacqueline Pan, O.D

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD-1043 Issued in HI

Practice address

4725 Bougainville Dr
Honolulu, HI 96818-3179

Phone

(808) 312-3878

NPI assigned

Jul 26, 2019

Last updated

Oct 7, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 PA, HI2 enrollments

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 2

Specialty

Optometry

Education

University of California - School of Optometry, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Optometric Associates PCGroup PAC ID 5698873891, 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Optometric Associates P.C.

  • Optometrist
  • Bethesda, MD
  • NPI 1629197520

  HI

  Medicare reassignment Care Compare group NPD
• For All Vision Care Inc.

  • Optometrist
  • Philadelphia, PA
  • NPI 1568920684
  Medicare reassignment NPD
• Brit Optical Inc

  dba deputy eyewear

  • Optician
  • Philadelphia, PA
  • NPI 1508977687
  NPD (past)
• Pennsylvania College of Optometry

  dba The Eye Institute

  • Optometrist
  • Philadelphia, PA
  • NPI 1134166572
  NPD (past)

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

{
    "created_epoch": "1564099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728259200000",
    "number": "1679127872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4725 BOUGAINVILLE DR",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968183179",
            "telephone_number": "808-312-3878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4725 BOUGAINVILLE DR",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968183179",
            "telephone_number": "808-312-3878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAN",
        "first_name": "JACQUELINE",
        "credential": "O.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-26",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "HI",
            "license": "OD-1043",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003595",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela E Nunn, M.D., Inc.
• Pamela G. Miyashiro LLC
• Alastair Adrian Pan, PA-C
• Diane Pan, M.D.
• Gui H Pan
• Katherine Lee Pan, DO
• Patrick E Pan, M.D.
• Panetta Psychotherapy
• Chelsea Ray O'Brien Pang, APRN-RX
• Derek Kwock Heen Pang, M.D.

• Optometrist in Honolulu, HI
• Providers in Honolulu, HI by specialty
• Optometrist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 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.