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NPI Code Detail

MEDICARE: DR. JESSICA P FANG O.D.

MEDICARE: DR. JESSICA P FANG O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152WP0200XPediatric Optometrist14420CA
2152WV0400XVision Therapy Optometrist14420CA
3152W00000XOptometrist14420CA

General Provider Information

NPI Number : 1376898825
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA P FANG O.D.
Provider Business Mailing Address
First Line : 521 EVERETT AVE
Second Line : UNIT C
City : MONTEREY PARK
State : CA
Zip : 91755-3476
Country : US
Telephone Number : 408-623-5078
Fax Number :
Provider Business Practice Location Address
First Line : 2700 E FOOTHILL BLVD
Second Line : SUITE 207
City : PASADENA
State : CA
Zip : 91107-7100
Country : US
Telephone Number : 626-578-9685
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2012
Last Update Date : 12/22/2021

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Directions to “ DR. JESSICA P FANG O.D.” Practice Location

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