Healthcare Provider Details

I. General information

NPI: 1699323329
Provider Name (Legal Business Name): CHAN FAMILY VISION CARE OPTOMETRIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SIERRA COLLEGE DR STE 100
GRASS VALLEY CA
95945-5088
US

IV. Provider business mailing address

360 SIERRA COLLEGE DR STE 100
GRASS VALLEY CA
95945-5088
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-3190
  • Fax: 530-273-5541
Mailing address:
  • Phone: 530-273-3190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIFFANY LAUREN CHAN
Title or Position: PRESIDENT
Credential: OD
Phone: 530-273-3190