Doctor Name: | DR. JACLYN T PHAN |
NPI Number: | 1114078235 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | O.D. |
License Number: | 3357 |
Business Practice Address: | 1912 201st Pl Se Suite 204 Bothell, WA - 980128570 |
Business Phone Number: | 4254856812 |
Business Fax Number: | |
Mailing Address: | 1912 201st Pl Se, Suite 204 BOTHELL |
State: | WA |
Postal Code: | 980128570 |
Phone Number: | 4254856812 |
Fax Number: | |
NPI Enumeration Date: | 01/16/2007 |
NPI Last Update Date: | 11/23/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 152WC0802X |
License Number: | 3357 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Optometrist |
Taxonomy Specialization: | Corneal and Contact Management |
Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |