Jennie Jessica Fan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

13246 Issued in CA

Practice address

1300 N Vermont Ave
Doctor's Tower, Suite 101
Los Angeles, CA 90027-6005

Phone

(323) 667-2102

NPI assigned

Jun 27, 2007

Last updated

Jul 8, 2007By 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

Credentials

Doctor of Osteopathy

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.

• Third Optometric Care of California

  • Optometrist
  • Rancho Cordova, CA
  • NPI 1013516103
  Medicare reassignment NPD
• Third Optometric Care of California PC

  dba Antelope Mall Vision Center Optometry

  • Optometrist
  • Palmdale, CA
  • NPI 1215824768
  NPD
• Third Optometric Care of California PC

  dba Golden Vision Optometry

  • Optometrist
  • Irvine, CA
  • NPI 1609461003
  NPD
• Third Optometric Care of California

  dba NorthPointe Optometric Center

  • Optometrist
  • Rialto, CA
  • NPI 1720752090
  NPD (past)

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801093570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28281 SOMERSET",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926922889",
            "telephone_number": "949-581-2239",
            "fax_number": "949-472-8163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N VERMONT AVE",
            "address_2": "DOCTOR'S TOWER, SUITE 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276005",
            "telephone_number": "323-667-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "JENNIE",
        "middle_name": "JESSICA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Fan
• Austin Fan, MD
• Chelsea Fan, PT, DPT, CSCS
• Gary Fan, MD
• Jacob C. Fan, MD
• Jessica Fan, MD
• Judith Fan, M.S.
• Michael S. Fan, MD
• Paul C Fan, MD
• Robert Fan, M.D.

• Optometrist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.