Individual provider · NPI-1

Jonathan Chan, O.D.

Optometrist · Corona, CA

NPI number1093123721
StatusActive
Last updated in NPPESOct 3, 2018

Details

NPI
1093123721
Entity type
Individual (NPI-1)
Name
Jonathan Chan
Credential
O.D.
Sex
Male
Sole proprietor
No
Enumeration date
Jul 25, 2014
Last updated
Oct 3, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
152W00000X Optometrist14864TLGCAYes

Practice location

2615 Tuscany St
Corona, CA 92881-4631

Phone 951-268-3036 · Fax 951-735-2864

Mailing address

18717 Stefani Ave
Cerritos, CA 90703-8438

Phone 562-537-8687

Other practice locations

477 E Colorado Blvd
Pasadena, CA 91101-2024

Phone 626-796-1191

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