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General NPI Number Information
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NPI Number | 1386286193
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Entity Type | Organization
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Legal Business Name | JONATHAN CHAN O.D. INC
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 2615 TUSCANY ST
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City | CORONA
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State | CA
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Zip | 92881
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Country | US
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Telephone | 951-268-3036
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 MAJESTIC DR
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City | CORONA
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State | CA
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Zip | 92880
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN CHAN
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Credential | OD
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Telephone | 562-537-8687
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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 |
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License Number State |
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