Healthcare Provider Details

I. General information

NPI: 1417951120
Provider Name (Legal Business Name): CHESLYN MEI GAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 PALOS VERDES MALL
WALNUT CREEK CA
94597-2228
US

IV. Provider business mailing address

1553 PALOS VERDES MALL
WALNUT CREEK CA
94597-2228
US

V. Phone/Fax

Practice location:
  • Phone: 925-934-9328
  • Fax: 925-934-9383
Mailing address:
  • Phone: 925-934-9328
  • Fax: 925-934-9383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 9246 T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: