Provider Demographics
NPI:1083612725
Name:CHU, VICTOR T (OD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:T
Last Name:CHU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6839 HIGHWAY 6 N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-1315
Mailing Address - Country:US
Mailing Address - Phone:281-859-9136
Mailing Address - Fax:281-550-2814
Practice Address - Street 1:6839 HIGHWAY 6 N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-1315
Practice Address - Country:US
Practice Address - Phone:281-859-9136
Practice Address - Fax:281-550-2814
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-08-04
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
TX2477T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82134QOtherBLUE CROSS BLUE SHIELD
TX0037QTOtherBLUE CROSS BLUE SHIELD
TXTXB102962OtherMEDICARE ID
TX4258040001Medicare NSC
TXTXB102962Medicare PIN
TXU12216Medicare UPIN