Healthcare Provider Details

I. General information

NPI: 1275966152
Provider Name (Legal Business Name): NANCY CHAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 10/09/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 OWENS STREET, 3RD FLOOR
SAN FRANCISCO CA
94158
US

IV. Provider business mailing address

300 WESTGATE DRIVE
SAN FRANCISCO CA
94127
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-5665
  • Fax: 901-722-3347
Mailing address:
  • Phone: 901-722-3250
  • Fax: 901-722-3347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14624TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3095
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: