Individual provider Active NPI

Joelle Chan

  • Optometrist
  • Fresno, CA
National Provider Identifier
1295379402
Registry record updated Oct 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
34424TLG Issued in CA
Practice address
2615 E Clinton Ave
Fresno, CA 93703-2223
Phone
(559) 228-5366
NPI assigned
Oct 30, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 34424TLG CA Primary

Addresses

Primary practice location

2615 E Clinton Ave
Fresno, CA 93703-2223

Mailing address

2615 E Clinton Ave
Fresno, CA 93703-2223

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200602002618 CA Practitioner - Optometry 0244651099 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
San Ramon Optometric Group Inc.Group PAC ID 6901835032, 2 clinicians

Practice addresses (Care Compare)

2723 Crow Canyon Rd
Suite 102
San Ramon, CA 94583-1635
Phone (925) 831-1084

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34424TLGCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
San Ramon Optometric Group Inc Optometrist CurrentSince May 28, 2020 Accepting new patients

Locations

2723 Crow Canyon Rd
Ste 102
San Ramon, CA 94583
Phone (925) 831-1084

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1572393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572393600000",
    "number": "1295379402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 E CLINTON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937032223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 E CLINTON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937032223",
            "telephone_number": "559-228-5366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JOELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-30",
        "last_updated": "2019-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34424TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.