C K Chan OD Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT6179TLG Issued in CA

Legal business name

C K CHAN OD INC

Practice address

2707 E Valley Blvd
Suite 101
West Covina, CA 91792-3196

Phone

(626) 854-0666

Fax

(626) 854-1865

NPI assigned

Jan 8, 2007

Last updated

May 22, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Chiu K Chan, O.D.

Title

President

Phone

(626) 854-0666

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242950400000",
    "number": "1598813297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2707 E VALLEY BLVD.",
            "address_2": "SUITE 101",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917923196",
            "telephone_number": "626-854-0666",
            "fax_number": "626-854-1865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2707 E VALLEY BLVD",
            "address_2": "SUITE 101",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917923196",
            "telephone_number": "626-854-0666",
            "fax_number": "626-854-1865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C K CHAN OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2009-05-22",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "CHIU",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-854-0666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT6179TLG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0061790",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0061791",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Michael Burwick, M.D., M.P.H.
• Liezel Bush
• Lauren Bustamante
• Luz Bustillos, CASE MANAGER
• Gloria A Byers
• Lupita Darlene Cabadas
• Julissa Cabral-Flores
• Elisamarie Cabrera, BSW
• Claudia Caceres
• Sharon Cai, RDN, IBCLC

• Optometrist in West Covina, CA
• Providers in West Covina, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2009; 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.