Kevin Chan, O.D.
Individual provider Active NPI Pediatric Optometrist · Tysons Corner, VA
NPI 1225461981 · NPPES record last updated Feb 14, 2019
Key facts
- NPI
- 1225461981
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Optometrist 152WP0200X
- License
- 0618002281 (VA)
- Practice address
- 8100 Boone Blvd Ste 150
Tysons Corner, VA 22182-2629 - Phone
- (703) 991-2766
- NPI assigned
- Aug 16, 2013
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA2733 | MD | MD | Optometrist |
| 0618002281 | VA | MD | Pediatric Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TA2733 | MD | |
| Pediatric Optometrist | 152WP0200X | 0618002281 | VA | Yes |
Addresses
Primary practice location
8100 Boone Blvd Ste 150
Tysons Corner, VA 22182-2629
Mailing address
8100 Boone Blvd Ste 150
Tysons Corner, VA 22182-2629
Phone (703) 991-2766
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- Krystle L Barton
- Tyler Brooks
- Ramesh G Chandra
- Monique Marie Chouraeshkenazi
- DD&Z Devoted Home Care, LLC
- Farshad Farhoumand
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All providers in Tysons Corner, VA · Pediatric Optometrist in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.