Provider Demographics
NPI:1972966513
Name:CHESTER C QUAN, OD
Entity type:Organization
Organization Name:CHESTER C QUAN, OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:CHOW
Authorized Official - Last Name:QUAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:415-753-5338
Mailing Address - Street 1:1551 SLOAT BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1222
Mailing Address - Country:US
Mailing Address - Phone:415-753-5338
Mailing Address - Fax:415-753-0978
Practice Address - Street 1:1551 SLOAT BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1222
Practice Address - Country:US
Practice Address - Phone:415-753-5338
Practice Address - Fax:415-753-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7739T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0077391Medicaid
SD0077390Medicare UPIN