MEDICARE: DR. CHESLYN MEI GAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT 9246 T	CA

General Provider Information

NPI Number	:	1417951120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHESLYN MEI GAN O.D.

Provider Business Mailing Address
First Line	:	1553 PALOS VERDES MALL
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2228
Country	:	US
Telephone Number	:	925-934-9328
Fax Number	:	925-934-9383

Provider Business Practice Location Address
First Line	:	1553 PALOS VERDES MALL
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2228
Country	:	US
Telephone Number	:	925-934-9328
Fax Number	:	925-934-9383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	08/25/2021

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