Provider Demographics
NPI:1689635542
Name:CHAN, STEPHANIE LAURA (OD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAURA
Last Name:CHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:675 YGNACIO VALLEY RD
Mailing Address - Street 2:STE B103
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3883
Mailing Address - Country:US
Mailing Address - Phone:925-933-4700
Mailing Address - Fax:925-933-4721
Practice Address - Street 1:675 YGNACIO VALLEY RD
Practice Address - Street 2:STE B103
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3883
Practice Address - Country:US
Practice Address - Phone:925-933-4700
Practice Address - Fax:925-933-4721
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11413T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist