Organization
GERALD D. CHAN, O.D. & LISA E. MOON, O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD CHAN O.D. (OWNER)
(530) 273-3190
Entity
Organization
Contact information
Practice address
360 SIERRA COLLEGE DR, SUITE 100, GRASS VALLEY, CA 95945-5088
(530) 273-3190
(530) 273-5541
Mailing address
360 SIERRA COLLEGE DR, SUITE 100, GRASS VALLEY, CA 95945-5088
(530) 273-3190
(530) 273-5541
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5832 T & 6088 T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP5473
RR MEDICARE
—
05
—
YYY49206Y
—
CA
Enumeration date
09/14/2006
Last updated
09/22/2010
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