Active NPI
Kevin Chan, O.D.
- Pediatric Optometrist
- Tysons Corner, VA
National Provider Identifier
1225461981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Optometrist
- License
- 0618002281
- Practice address
- 8100 Boone Blvd Ste 150
Tysons Corner, VA 22182-2629 - Phone
- (703) 991-2766
- NPI assigned
- Aug 16, 2013
- Last updated
- Feb 14, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TA2733 | MD | |
| Pediatric Optometrist | 152WP0200X | 0618002281 | VA | Primary |
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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA2733 | MD | MD | Optometrist |
| 0618002281 | VA | MD | Pediatric Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550102400000",
"number": "1225461981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8100 BOONE BLVD STE 150",
"city": "TYSONS CORNER",
"state": "VA",
"postal_code": "221822629",
"telephone_number": "703-991-2766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8100 BOONE BLVD STE 150",
"city": "TYSONS CORNER",
"state": "VA",
"postal_code": "221822629",
"telephone_number": "703-991-2766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-16",
"last_updated": "2019-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MD",
"license": "TA2733",
"primary": false
},
{
"code": "152WP0200X",
"taxonomy_group": "",
"desc": "Optometrist, Pediatrics",
"state": "VA",
"license": "0618002281",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tysons Corner, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.