Provider Demographics
NPI:1083601959
Name:CHAN, EVE (OD)
Entity Type:Individual
Prefix:DR
First Name:EVE
Middle Name:
Last Name:CHAN
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 1:210 SKYLINE PLZ
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-3825
Mailing Address - Country:US
Mailing Address - Phone:650-755-2000
Mailing Address - Fax:
Practice Address - Street 1:210 SKYLINE PLZ
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-3825
Practice Address - Country:US
Practice Address - Phone:650-755-2000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10662T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD1066201Medicaid
CASD1066201Medicaid
CASD01066201Medicare ID - Type Unspecified