Provider Demographics
NPI:1598813297
Name:C K CHAN OD INC
Entity Type:Organization
Organization Name:C K CHAN OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIU
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-854-0666
Mailing Address - Street 1:2707 E VALLEY BLVD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-3196
Mailing Address - Country:US
Mailing Address - Phone:626-854-0666
Mailing Address - Fax:626-854-1865
Practice Address - Street 1:2707 E VALLEY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3196
Practice Address - Country:US
Practice Address - Phone:626-854-0666
Practice Address - Fax:626-854-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6179TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0061790Medicaid
CASD0061791Medicaid
CAOP6179AMedicare ID - Type UnspecifiedMEDICARE AT RHO
CASD0061791Medicaid
CAOP6179Medicare ID - Type UnspecifiedMEDICARE AT MPO
CASD0061790Medicaid