=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558405803
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZOEE CHAN O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2007
-----------------------------------------------------
Last Update Date | 02/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1925 LANDSTOWN CENTRE WAY STE 250
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23456-1649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-430-8800
-----------------------------------------------------
Fax | 757-430-8801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2021 JOLIET CT
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23456-5718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-470-1334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0618001176
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------