Provider Demographics
NPI:1336162171
Name:QUAN, CHESTER CHOW (OD)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:CHOW
Last Name:QUAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 SLOAT BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1222
Mailing Address - Country:US
Mailing Address - Phone:415-753-5338
Mailing Address - Fax:415-753-0978
Practice Address - Street 1:1551 SLOAT BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1222
Practice Address - Country:US
Practice Address - Phone:415-753-5338
Practice Address - Fax:415-753-0978
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2015-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7739T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0077391Medicaid
CASD0077391Medicaid
CASD0077390Medicare PIN