MEDICARE: DR. JOSE ANTONIO CHAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV5104	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326046939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE ANTONIO CHAN O.D.

Provider Business Mailing Address
First Line	:	2537A FRANCIS LEWIS BLVD
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-1142
Country	:	US
Telephone Number	:	718-281-2273
Fax Number	:	718-281-2232

Provider Business Practice Location Address
First Line	:	2537A FRANCIS LEWIS BLVD
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-1142
Country	:	US
Telephone Number	:	718-281-2273
Fax Number	:	718-281-2232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/31/2012

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