Organization
RANGRAM CHANDRAN MD INC
Active
Other names
ADVANCED RETINA INSTITUTE
Organization subpart
No
Provider details
NPI number
Authorized official
RANGRAM CHANDRAN MD (PRESIDENT)
(415) 535-7900
Entity
Organization
Contact information
Practice address
304 BANNER CT, SUITE 1, MODESTO, CA 95356-9194
(209) 572-2020
(209) 572-2040
Mailing address
PO BOX 576067, MODESTO, CA 95357-6067
(415) 535-7900
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
A81157
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA131027
MEDICARE PTAN
—
Enumeration date
05/21/2014
Last updated
11/28/2014
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