Provider Demographics
NPI:1891809729
Name:PAN, GRACE JING-WEI (OD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:JING-WEI
Last Name:PAN
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 1:10123 N WOLFE RD
Mailing Address - Street 2:SUITE 2144
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2509
Mailing Address - Country:US
Mailing Address - Phone:408-446-4004
Mailing Address - Fax:
Practice Address - Street 1:10123 N WOLFE RD
Practice Address - Street 2:SUITE 2144
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2509
Practice Address - Country:US
Practice Address - Phone:408-446-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009853152W00000X
CAOPT 13882 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist