Individual
DR. JENNIFER T. PHA M
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
17028 41ST PL W, LYNNWOOD, WA 98037-6969
(425) 787-0943
(425) 787-0943
Mailing address
17028 41ST PL W, LYNNWOOD, WA 98037-6969
(425) 787-0943
(425) 787-0943
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00004040
WA
152W00000X
Optometrist
OPT 12971 TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023PH
REGENCE PROVIDER NUMBER
WA
01
—
4615PH
REGENCE PROVIDER NUMBER
WA
Enumeration date
11/30/2006
Last updated
07/08/2007
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