Individual
DR. ETHAN CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1153 2ND AVE, NEW YORK, NY 10065-8505
(212) 421-3655
Mailing address
2840 JACKSON AVE APT 12M, LONG ISLAND CITY, NY 11101-3304
(626) 373-4388
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1164
NV
152W00000X
Optometrist
ORT010014
NY
Other
Enumeration date
06/05/2023
Last updated
09/12/2024
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