Healthcare Provider Details

I. General information

NPI: 1427443316
Provider Name (Legal Business Name): ERIC H CHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

IV. Provider business mailing address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3080
  • Fax: 951-784-3258
Mailing address:
  • Phone: 951-782-3080
  • Fax: 951-784-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberA160341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: