Provider Demographics
NPI:1689012577
Name:CHAN, HOWAI JENNY (OD)
Entity Type:Individual
Prefix:DR
First Name:HOWAI
Middle Name:JENNY
Last Name:CHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:515 S LUZERNE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3716
Mailing Address - Country:US
Mailing Address - Phone:856-383-6361
Mailing Address - Fax:
Practice Address - Street 1:6080 FALLS RD STE 104
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2383
Practice Address - Country:US
Practice Address - Phone:410-553-5778
Practice Address - Fax:410-237-6937
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2352152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist