Tai M Chan, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

1529 Issued in WI

Practice address

1 W Lincoln St
Waupun, WI 53963-1949

Phone

(920) 324-5577

NPI assigned

Feb 13, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Agnesian Healthcare Inc

  • Community/Retail Pharmacy
  • Waupun, WI
  • NPI 1366417917
  NPD (past)

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508908872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 MADISON ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162531",
            "telephone_number": "608-347-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 W LINCOLN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539631949",
            "telephone_number": "920-324-5577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "TAI",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "WI",
            "license": "1529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bert C Callahan, MD
• Todd Richard Callister, MD
• Jeffrey J Campbell, LCSW
• Ethan A. Carruthers, PHARMD
• Jeffrey Lee Champion, DDS
• Teresa J Chouinard, APNP
• Christian Home and Rehabilitation Center, Inc.
• Christian Home Care and Rehab Center LLC
• City of Waupun
• Community Psychological Services of Waupun LLC

• Corneal and Contact Management Optometrist in Waupun, WI
• Providers in Waupun, WI by specialty
• Corneal and Contact Management Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.