Provider Demographics
NPI:1366018749
Name:OBIANYO, CHAZ (ABOC)
Entity Type:Individual
Prefix:MR
First Name:CHAZ
Middle Name:
Last Name:OBIANYO
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 RAY LEONARD RD
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4226
Mailing Address - Country:US
Mailing Address - Phone:202-921-2472
Mailing Address - Fax:
Practice Address - Street 1:2007 RAY LEONARD RD
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4226
Practice Address - Country:US
Practice Address - Phone:202-921-2472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD224188156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician