MEDICARE: JACQUELYN CHAN OD

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	11510TG	TX

General Provider Information

NPI Number	:	1467338046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN CHAN OD

Provider Business Mailing Address
First Line	:	1329 W DAVIS ST
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2309
Country	:	US
Telephone Number	:	936-441-3937
Fax Number	:	936-441-3943

Provider Business Practice Location Address
First Line	:	1329 W DAVIS ST
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2309
Country	:	US
Telephone Number	:	936-441-3937
Fax Number	:	936-441-3943

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

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	02/26/2026

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Directions to “ JACQUELYN CHAN OD” Practice Location

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