Provider Demographics
NPI:1437196789
Name:NGAN, JANICE PANDORA (OD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:PANDORA
Last Name:NGAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 WOODRIDGE DR SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3818
Mailing Address - Country:US
Mailing Address - Phone:360-871-7837
Mailing Address - Fax:
Practice Address - Street 1:10218 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4294
Practice Address - Country:US
Practice Address - Phone:425-455-4602
Practice Address - Fax:425-709-6879
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4002TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023174Medicaid
WA2023174Medicaid