JACQUELINE PAN (O.D) – Optometrist, NPI 1679127872
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,771 OPTOMETRY in PA
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Provider Addresses for JACQUELINE PAN (O.D)
1200, West Godfrey Avenue, Fern Rock, Philadelphia, Philadelphia County, Pennsylvania, 19141, United States
PHILADELPHIA, PA 191413323
Phone: (215) 276-6000
Fax: (215) 276-1329
Type: Mailing
4725 BOUGAINVILLE DR
HONOLULU, HI 968183179
Phone: (808) 312-3878
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-11-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20190821002177 | I | Optometry | PA | TBD |
| I20241105003785 | I | Optometry | HI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 19141)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O P T O M E T R Y | SC | |
| O P T O M E T R Y | VA | |
| O P T O M E T R Y | MD | |
| O P T O M E T R Y | MD | |
| - | VA | |
| - | CA | |
| O P T O M E T R Y | HI | |
| - | OK | |
| O P T O M E T R Y | VA |
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