Organization
JENNY FAN, OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM FAN O.D. (SECRETARY)
(972) 262-4391
Entity
Organization
Contact information
Practice address
708 E 15TH ST, SUITE A, PLANO, TX 75074-5712
(972) 509-8555
Mailing address
708 E 15TH ST, SUITE A, PLANO, TX 75074-5712
(972) 509-8555
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5093TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178744201
—
TX
Enumeration date
01/26/2007
Last updated
05/17/2024
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