Provider Demographics
NPI:1043371255
Name:CHONKO, LAURA M (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:CHONKO
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 1:33532 AUGUSTA WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2782
Mailing Address - Country:US
Mailing Address - Phone:440-937-3711
Mailing Address - Fax:
Practice Address - Street 1:24801 BROOKPARK RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3487
Practice Address - Country:US
Practice Address - Phone:440-979-9546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5017152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist