Provider Demographics
NPI:1437125523
Name:CHAO, CHRISTINE JJ (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JJ
Last Name:CHAO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:JOY
Other - Last Name:JEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1970 LAKE BLVD
Mailing Address - Street 2:STE 7
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-5663
Mailing Address - Country:US
Mailing Address - Phone:530-756-9393
Mailing Address - Fax:530-756-9398
Practice Address - Street 1:1970 LAKE BLVD
Practice Address - Street 2:STE 7
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5663
Practice Address - Country:US
Practice Address - Phone:530-756-9393
Practice Address - Fax:530-756-9398
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10612T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU89020Medicare UPIN
CAFO423AMedicare PIN