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DR. ETHAN CHAN O.D.
NPI 1710671565
Optometrist in New York, NY

Active since June 05, 2023PECOS Enrolled
1153 2ND AVE, NEW YORK, NY 10065(212) 421-3655 Get Directions Write a Review

NPPES record last updated: September 12, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 12, 2024, Jun 5, 2023 (2 updates tracked since 2023).

About Dr. Ethan Chan O.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ETHAN CHAN O.D. (NPI 1710671565) is an individual optometrist in New York, New York, licensed in Nevada (1164) and active in the NPI registry since June 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1710671565
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameDR. ETHAN CHANCredential: O.D.
Location Address1153 2ND AVENew York, NY 10065-8505
Mailing Address2840 Jackson Ave Apt 12mLong Island City, NY 11101-3304 · (626) 373-4388
Phone(212) 421-3655
Sole ProprietorNo
Enumeration DateJune 5, 2023
Last NPPES UpdateSeptember 12, 20242 updates tracked since enumeration
NPPES CertifiedSeptember 12, 2024
✔ NPI 1710671565 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
Licenses✔ Licensed in NV · 1164✔ Licensed in NY · ORT010014
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
1153 2ND AVE, New York, NY 10065
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Ethan Chan O.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Ethan Chan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Gammoh Premier Vision LLC
2,233 mi
Optometrist
556 N EASTERN AVE STE A
Las Vegas, NV 89101
  • Reassigned Medicare billing, Nevada enrollment
  • 16 clinicians in this Medicare group
NPI 1528304458 (702) 840-2020

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10065 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$150.24 typical visit price
range $65.69 – $198.19
Typical copayment $37.56 (range $16.42 – $49.54)
Most-billed visit code 99204
Established Patient
$81.44 typical visit price
range $21.20 – $160.66
Typical copayment $20.36 (range $5.30 – $40.16)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

R & D OPTICAL INC.
Technician/Technologist (Optician)
1153 2ND AVE
NEW YORK, NY 10065
New York County (212) 421-3655

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethan Chan's NPI number?

The NPI number for Ethan Chan is 1710671565. It was assigned to this individual provider in the NPPES registry on June 5, 2023.

Where is Ethan Chan located?

Ethan Chan practices at 1153 2nd Ave, New York, NY 10065. The listed phone number is (212) 421-3655.

What is Ethan Chan's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Ethan Chan enrolled in Medicare?

Yes. Ethan Chan is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Ethan Chan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ethan Chan reassigns Medicare benefits to Gammoh Premier Vision LLC (Las Vegas, NV). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ethan Chan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Ethan Chan accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas list Ethan Chan as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ethan Chan was last updated on September 12, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.