Provider Demographics
NPI:1285862110
Name:JAN, ERIC CHI-JUN (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:CHI-JUN
Last Name:JAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14008 GLEN MILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3427
Mailing Address - Country:US
Mailing Address - Phone:301-996-7806
Mailing Address - Fax:
Practice Address - Street 1:14008 GLEN MILL RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3427
Practice Address - Country:US
Practice Address - Phone:301-996-7806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001846152W00000X
MDTA2152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist