Individual
FANNY W CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
738 PRATER WAY, SPARKS, NV 89431-4466
(775) 356-3937
(775) 356-0808
Mailing address
738 PRATER WAY, SPARKS, NV 89431-4466
(775) 356-3937
(775) 356-0808
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
319
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002507626
—
NV
01
—
11026
MES, WMCA
NV
01
—
1316460001
MC DMERC
NV
01
—
15186
MES,LOVELOCK
NV
01
—
33574
MEDICARE PART B
NV
01
—
410043037
RAILROAD MEDICARE
NV
Enumeration date
10/20/2006
Last updated
07/09/2010
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