Healthcare Provider Details

I. General information

NPI: 1538063417
Provider Name (Legal Business Name): CHRISTOPHER QUAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E 2ND ST
POMONA CA
91766-1854
US

IV. Provider business mailing address

17192 MURPHY AVE UNIT 18733
IRVINE CA
92623-0522
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-6116
  • Fax:
Mailing address:
  • Phone: 562-277-2285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: