William Fan, OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

4925TG Issued in TX

Legal business name

WILLIAM FAN, OD PA

Practice address

625 W Dickey Rd
Grand Prairie, TX 75051-3129

Phone

(972) 262-4391

Fax

(972) 264-6135

NPI assigned

Feb 17, 2007

Last updated

Mar 23, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Willliam Fan, O.D.

Title

President

Phone

(972) 262-4391

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jenny Fan, O.D.

  • Optometrist
  • Plano, TX
  • NPI 1669466348
  NPD (past)

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

{
    "created_epoch": "1171670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237766400000",
    "number": "1710021274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 W DICKEY RD",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750513129",
            "telephone_number": "972-262-4391",
            "fax_number": "972-264-6135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 W DICKEY RD",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750513129",
            "telephone_number": "972-262-4391",
            "fax_number": "972-264-6135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM FAN, OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-17",
        "last_updated": "2009-03-23",
        "status": "A",
        "authorized_official_last_name": "FAN",
        "authorized_official_first_name": "WILLLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-262-4391",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "4925TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112248401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlos Guillermo Wiesse, D.D.S.
• Brooke Wiggins
• Brianna Cheyenne Wilcox-Curley
• Shelly Rose Wilkes, LPN
• Graci Wilkins
• William J. Luck (Luck Optical)
• Kimberlee Williams, RN
• Kimberly Williams
• Megan Janelle Williams, MS, LPC
• Mercy Nkechinyere Williams, FNP

• Optometrist in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.