Provider Demographics
NPI:1063502565
Name:CHAO, WALTER J (OD, AP)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:J
Last Name:CHAO
Suffix:
Gender:M
Credentials:OD, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7867 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6916
Mailing Address - Country:US
Mailing Address - Phone:954-966-4335
Mailing Address - Fax:954-966-4891
Practice Address - Street 1:7867 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6916
Practice Address - Country:US
Practice Address - Phone:954-966-4335
Practice Address - Fax:954-966-4891
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC-1819152W00000X, 152WP0200X
FLAP466171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078481800Medicaid
FLT93910Medicare UPIN
FL078481800Medicaid