Gerald Dennis Chan, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5832 T Issued in CA

Practice address

360 Sierra College Dr
Suite 100
Grass Valley, CA 95945-5088

Phone

(530) 273-3190

Fax

(530) 273-5541

NPI assigned

Aug 22, 2005

Last updated

Aug 19, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Dr. Jerry Chan Other name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of California - School of Optometry, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chan Family Vision Care Optometric IncGroup PAC ID 8921433830, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chan Family Vision Care Optometric Inc

  • Optometrist
  • Grass Valley, CA
  • NPI 1699323329
  Medicare reassignment Care Compare group NPD
• Gerald D. Chan, O.D. & Lisa E. Moon, O.D.

  • Optometrist
  • Grass Valley, CA
  • NPI 1538264601
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219104000000",
    "number": "1275525644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 SIERRA COLLEGE DR",
            "address_2": "SUITE 100",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959455088",
            "telephone_number": "530-273-3190",
            "fax_number": "530-273-5541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 SIERRA COLLEGE DR",
            "address_2": "SUITE 100",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959455088",
            "telephone_number": "530-273-3190",
            "fax_number": "530-273-5541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "GERALD",
        "middle_name": "DENNIS",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2008-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "5832 T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE NSC",
            "identifier": "0366860001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "YYY49206Y",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE PIN",
            "identifier": "YYY49206Y",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JERRY",
            "last_name": "CHAN",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Carol Susan Chambers, PSYD
• Jennifer Sue Chambers, MFC
• Holly Champagne, RN
• Chan Family Vision Care Optometric Inc
• Chan Family Vision Care Optometric Inc
• Samuel Chan, M.D.
• Simon CHI Yan Chan, M.D.
• Tiffany Lauren Chan, O.D.
• Chapa-de Indian Health Program Inc (Chapa-De Indian Health Program Pharmacy-Grass Valley)
• Chapa-de Indian Health Program, Inc.

• Optometrist in Grass Valley, CA
• Providers in Grass Valley, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.