Provider Demographics
NPI:1861556771
Name:CHANT, WESLEY JUAN (OD)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:JUAN
Last Name:CHANT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 IRVINE BLVD
Mailing Address - Street 2:#87
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2400
Mailing Address - Country:US
Mailing Address - Phone:626-236-8571
Mailing Address - Fax:
Practice Address - Street 1:13662 JAMBOREE RD STE A
Practice Address - Street 2:THE MARKET PLACE
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-1224
Practice Address - Country:US
Practice Address - Phone:714-508-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV01399Medicare UPIN
CAWOP12553Medicare ID - Type Unspecified