Individual
WALLACE CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2126A S ARCHER AVE, CHICAGO, IL 60616-1514
(312) 949-1888
(312) 949-0288
Mailing address
2126A S ARCHER AVE, CHICAGO, IL 60616-1514
(312) 949-1888
(312) 949-0288
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-008575
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008575
—
IL
Enumeration date
05/09/2006
Last updated
11/11/2008
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