Provider Demographics
NPI:1487632626
Name:QUACH, CHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAN
Middle Name:
Last Name:QUACH
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 1:5866 E SAM HOUSTON PKWY N STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-2527
Mailing Address - Country:US
Mailing Address - Phone:281-436-1757
Mailing Address - Fax:281-454-4825
Practice Address - Street 1:5866 E SAM HOUSTON PKWY N STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-2527
Practice Address - Country:US
Practice Address - Phone:281-436-1757
Practice Address - Fax:281-454-4825
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6561TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB104561OtherMEDICARE- INDIVIDUAL PTAN
TX1800161OtherMEDICAID - INDIVIDUAL ID
TXB104561OtherMEDICARE- INDIVIDUAL PTAN