Ethan Chan, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1164 Issued in NV

Practice address

1153 2ND Ave
New York, NY 10065-8505

Phone

(212) 421-3655

NPI assigned

Jun 5, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

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

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 and National Provider Directory roles.

• Gammoh Premier Vision LLC

  • Optometrist
  • Las Vegas, NV
  • NPI 1528304458
  Medicare reassignment NPD
• R & D Optical Inc.

  • Optician
  • New York, NY
  • NPI 1114274594
  NPD (past)
• Eye Doc Group LLC

  • Optician
  • Las Vegas, NV
  • NPI 1750042396
  NPD (past)

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

{
    "created_epoch": "1685923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1710671565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2840 JACKSON AVE APT 12M",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111013304",
            "telephone_number": "626-373-4388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1153 2ND AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100658505",
            "telephone_number": "212-421-3655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-05",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NV",
            "license": "1164",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "ORT010014",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Linda Chan, M.D.
• Eric Chan
• Eric Justin Chan
• Erica Chan
• Erin Chan, M.A.
• Ethan CHI-Win Chan, PHARM.D
• Evangeline Chan, RD
• Evelyn May-Lan Chan, L.AC.
• Fai Chan, PHARMD
• Fanny Chan, DPT

• Optometrist in New York, NY
• Providers in New York, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.