Provider Demographics
NPI:1124043682
Name:CHU, HARREN (OD)
Entity Type:Individual
Prefix:DR
First Name:HARREN
Middle Name:
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 1:43625 MISSION BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5852
Mailing Address - Country:US
Mailing Address - Phone:510-623-8889
Mailing Address - Fax:510-623-1849
Practice Address - Street 1:43625 MISSION BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5852
Practice Address - Country:US
Practice Address - Phone:510-623-8889
Practice Address - Fax:510-623-1849
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA10680T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8179OtherAVP
210887OtherEYEMED
CASD0106800Medicaid
SD010680T0OtherBLUE SHIELD
897328OtherSAFEGUARD
CA10680OtherVBA
12483OtherMES
1124043682OtherVSP
45800OtherHEALTHNET
1161020001Medicare NSC
12483OtherMES
45800OtherHEALTHNET