Provider Demographics
NPI:1285742601
Name:PAN, THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:PAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2110 FOREST AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1469
Mailing Address - Country:US
Mailing Address - Phone:408-295-3433
Mailing Address - Fax:408-293-4872
Practice Address - Street 1:2110 FOREST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1469
Practice Address - Country:US
Practice Address - Phone:408-295-3433
Practice Address - Fax:408-293-4872
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12849T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12849TOtherOPTOMETRY LICENSE
CA12849TOtherOPTOMETRY LICENSE