MEDICARE: DR. CHAN QUACH OD

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	152WV0400X	Vision Therapy Optometrist	6561TG	TX
2	152W00000X	Optometrist	6561TG	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	TXB104561	OTHER		MEDICARE- INDIVIDUAL PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487632626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAN QUACH OD

Provider Business Mailing Address
First Line	:	5866 E SAM HOUSTON PKWY N STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-2527
Country	:	US
Telephone Number	:	281-436-1757
Fax Number	:	281-454-4825

Provider Business Practice Location Address
First Line	:	5866 E SAM HOUSTON PKWY N STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-2527
Country	:	US
Telephone Number	:	281-436-1757
Fax Number	:	281-454-4825

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	07/29/2025

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Directions to “ DR. CHAN QUACH OD” Practice Location

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