Provider Demographics
NPI:1215582176
Name:CHAVEZ, ANTHONY (OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:CHAVEZ
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 1:1360 E HERNDON AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3326
Mailing Address - Country:US
Mailing Address - Phone:559-449-5010
Mailing Address - Fax:559-449-5014
Practice Address - Street 1:1360 E HERNDON AVE STE 401
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3326
Practice Address - Country:US
Practice Address - Phone:559-449-5019
Practice Address - Fax:559-449-5044
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist