Provider Demographics
NPI:1245200773
Name:CHIN, RAYMOND S (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:S
Last Name:CHIN
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 1:1227 MANET DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2822
Mailing Address - Country:US
Mailing Address - Phone:408-746-0768
Mailing Address - Fax:
Practice Address - Street 1:770 SCOTT BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6927
Practice Address - Country:US
Practice Address - Phone:408-296-0511
Practice Address - Fax:408-296-1647
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11116T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11116TOtherCA LICENSE NUMBER
CA11116TOtherCA LICENSE NUMBER
CAMC0668585OtherDEA NUMBER
CAYYY49956YMedicare PIN