Provider Demographics
NPI:1861844847
Name:FANG, JEFFREY ERICK (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ERICK
Last Name:FANG
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 1:523 PINE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1722
Mailing Address - Country:US
Mailing Address - Phone:206-652-9000
Mailing Address - Fax:206-381-1732
Practice Address - Street 1:523 PINE ST STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1722
Practice Address - Country:US
Practice Address - Phone:206-652-9000
Practice Address - Fax:206-381-1732
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60661962152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist