Provider Demographics
NPI:1417115510
Name:CHACHA, NEENA (OD)
Entity Type:Individual
Prefix:DR
First Name:NEENA
Middle Name:
Last Name:CHACHA
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 1:190 FORTY FOOT RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-2852
Mailing Address - Country:US
Mailing Address - Phone:267-263-4478
Mailing Address - Fax:267-263-4593
Practice Address - Street 1:190 FORTY FOOT RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-2852
Practice Address - Country:US
Practice Address - Phone:267-263-4478
Practice Address - Fax:267-263-4593
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024971920001Medicaid
PA1024971920001Medicaid