Provider Demographics
NPI:1467532440
Name:CHIA, SAMUEL S (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:S
Last Name:CHIA
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:756 ADMIRAL CALLAGHAN LN
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-3650
Mailing Address - Country:US
Mailing Address - Phone:707-554-1215
Mailing Address - Fax:707-554-9929
Practice Address - Street 1:756 ADMIRAL CALLAGHAN LN
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-3650
Practice Address - Country:US
Practice Address - Phone:707-554-1215
Practice Address - Fax:707-554-9929
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CACA8436T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU42640Medicare UPIN