Healthcare Provider Details

I. General information

NPI: 1972966513
Provider Name (Legal Business Name): CHESTER C QUAN, OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 SLOAT BLVD
SAN FRANCISCO CA
94132-1222
US

IV. Provider business mailing address

1551 SLOAT BLVD
SAN FRANCISCO CA
94132-1222
US

V. Phone/Fax

Practice location:
  • Phone: 415-753-5338
  • Fax: 415-753-0978
Mailing address:
  • Phone: 415-753-5338
  • Fax: 415-753-0978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number7739T
License Number StateCA

VIII. Authorized Official

Name: DR. CHESTER CHOW QUAN
Title or Position: OWNER
Credential: O.D.
Phone: 415-753-5338