Provider Demographics
NPI:1043669062
Name:SUN, CHAO
Entity Type:Individual
Prefix:
First Name:CHAO
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11809 WILCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-1919
Mailing Address - Country:US
Mailing Address - Phone:346-207-3137
Mailing Address - Fax:281-933-8612
Practice Address - Street 1:1836 MEZGER DR
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-5192
Practice Address - Country:US
Practice Address - Phone:857-526-3947
Practice Address - Fax:281-933-8612
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8979T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist