Healthcare Provider Details

I. General information

NPI: 1669365912
Provider Name (Legal Business Name): JAMES HAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 PRINCE WILLIAM PKWY
WOODBRIDGE VA
22192-4145
US

IV. Provider business mailing address

116 STAFFORD CIR
LANSDALE PA
19446-6403
US

V. Phone/Fax

Practice location:
  • Phone: 703-763-1390
  • Fax: 703-763-1395
Mailing address:
  • Phone: 484-368-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004292
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: