Provider Demographics
NPI:1144891714
Name:CHESLYN GAN OPTOMETRIST INC
Entity type:Organization
Organization Name:CHESLYN GAN OPTOMETRIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESLYN
Authorized Official - Middle Name:MEI
Authorized Official - Last Name:GAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-934-9328
Mailing Address - Street 1:1553 PALOS VERDES MALL
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2228
Mailing Address - Country:US
Mailing Address - Phone:925-934-9328
Mailing Address - Fax:925-934-9383
Practice Address - Street 1:1553 PALOS VERDES MALL
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2228
Practice Address - Country:US
Practice Address - Phone:925-934-9328
Practice Address - Fax:925-934-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty