Provider Demographics
NPI:1003969254
Name:CHIN, DANIEL (DOCTOR OF OPTOMETRY)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:CHIN
Suffix:
Gender:M
Credentials:DOCTOR OF OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 1/2 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501
Mailing Address - Country:US
Mailing Address - Phone:510-523-1344
Mailing Address - Fax:510-523-2089
Practice Address - Street 1:1409 (HALF) PARK STREET
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501
Practice Address - Country:US
Practice Address - Phone:510-523-1344
Practice Address - Fax:510-523-2089
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9785T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0097850Medicaid
CASD0097850Medicare ID - Type Unspecified
CAU25822Medicare UPIN