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General NPI Number Information
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NPI Number | 1225117286
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Entity Type | Individual
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Provider Name | SELINA P CHAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1689 ARDEN WAY STE 1344
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City | SACRAMENTO
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State | CA
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Zip | 95815-4030
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Country | US
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Telephone | 916-922-5666
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Fax |
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Provider Business Mailing Address
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Address Line | 9301 TAMPA AVE #62
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City | NORTHRIDGE
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State | CA
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Zip | 91324-2503
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Country | US
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Telephone | 818-885-7215
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Fax | 818-709-2292
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10879
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License Number State | CA
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