Active NPI
David Chan, O.D.
- Optometrist
- Rocklin, CA
National Provider Identifier
1801971981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 7755T
- Practice address
- 4240 Rocklin Rd
Suite #3
Rocklin, CA 95677-2862 - Phone
- (916) 624-0508
- Fax
- (916) 624-4727
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 7755T | CA | Primary |
Addresses
Primary practice location
4240 Rocklin Rd
Suite #3
Rocklin, CA 95677-2862
Mailing address
4240 Rocklin Rd
Suite #3
Rocklin, CA 95677-2862
Phone (916) 624-0508
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0868590001 | Other | CA | DMEPOS SUPPLIER NUMBER |
| SD0077550 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7755T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801971981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4240 ROCKLIN RD",
"address_2": "SUITE #3",
"city": "ROCKLIN",
"state": "CA",
"postal_code": "956772862",
"telephone_number": "916-624-0508",
"fax_number": "916-624-4727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4240 ROCKLIN RD",
"address_2": "SUITE #3",
"city": "ROCKLIN",
"state": "CA",
"postal_code": "956772862",
"telephone_number": "916-624-0508",
"fax_number": "916-624-4727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "DAVID",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "7755T",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMEPOS SUPPLIER NUMBER",
"identifier": "0868590001",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0077550",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rocklin, CA
Sources for this page
- 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.