Provider Demographics
NPI:1033321054
Name:CHU, CONNIE H (OD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:H
Last Name:CHU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MONTELENA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2458
Mailing Address - Country:US
Mailing Address - Phone:714-389-2804
Mailing Address - Fax:
Practice Address - Street 1:33961 DOHENY PARK RD
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-4835
Practice Address - Country:US
Practice Address - Phone:949-443-3794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11657T152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics