Basic Information
Provider Information
NPI: 1407074743
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAU
FirstName: NHI
MiddleName: TUYET
NamePrefix:  
NameSuffix:  
Credential: DOCTOR OF OPTOMETRY
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 233 RIDGE VISTA AVE
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951271951
CountryCode: US
TelephoneNumber: 5035448195
FaxNumber:  
Practice Location
Address1: 2615 E CLINTON AVE
Address2:  
City: FRESNO
State: CA
PostalCode: 937032223
CountryCode: US
TelephoneNumber: 5592256100
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/23/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X13153CAY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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