Healthcare Provider Details

I. General information

NPI: 1487632626
Provider Name (Legal Business Name): CHAN QUACH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5866 E SAM HOUSTON PKWY N STE B
HOUSTON TX
77049-2527
US

IV. Provider business mailing address

5866 E SAM HOUSTON PKWY N STE B
HOUSTON TX
77049-2527
US

V. Phone/Fax

Practice location:
  • Phone: 281-436-1757
  • Fax: 281-454-4825
Mailing address:
  • Phone: 281-436-1757
  • Fax: 281-454-4825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number6561TG
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6561TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: