Provider Demographics
NPI:1750440814
Name:CHAN, PARD H (O D)
Entity type:Individual
Prefix:DR
First Name:PARD
Middle Name:H
Last Name:CHAN
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 OVERLOOK BLVD
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-5290
Mailing Address - Country:US
Mailing Address - Phone:845-426-2044
Mailing Address - Fax:
Practice Address - Street 1:50 OVERLOOK BLVD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-5290
Practice Address - Country:US
Practice Address - Phone:845-426-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT004766152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTUV004766OtherNY STATE LICENSE #
NYTUV004766OtherNY STATE LICENSE #