NPIMap

Organization Active NPI

John Chan O.D. PLLC

  • Optometrist
  • Henderson, NV
National Provider Identifier
1588295331
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
JOHN CHAN O.D. PLLC
Practice address
695 S Green Valley Pkwy
Henderson, NV 89052-0404
Phone
(702) 941-7898
NPI assigned
Jan 30, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2020

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

Authorized official

Name
John Kuang-Yu Chan, ODNPI 1790185932
Title
Owner
Phone
(909) 263-3465

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

695 S Green Valley Pkwy
Henderson, NV 89052-0404

Mailing address

5581 Anshan St
Las Vegas, NV 89148-7719
Phone (909) 263-3465

Other names 1

  • Arclight Eye Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200804000755 NV Part B Supplier - Clinic/Group Practice 1052736345 Receives reassigned benefits from 8 practitioners
Practice locations: Henderson, NV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1588295331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5581 ANSHAN ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891487719",
            "telephone_number": "909-263-3465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 S GREEN VALLEY PKWY",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890520404",
            "telephone_number": "702-941-7898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN CHAN O.D. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-30",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "KUANG-YU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-263-3465",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arclight Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.