Provider Demographics
NPI:1568432110
Name:CHOW, KEITH DARREN (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:DARREN
Last Name:CHOW
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 1:1673 BRANHAM LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-5211
Mailing Address - Country:US
Mailing Address - Phone:408-269-6861
Mailing Address - Fax:408-269-6863
Practice Address - Street 1:1673 BRANHAM LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-5211
Practice Address - Country:US
Practice Address - Phone:408-269-6861
Practice Address - Fax:408-269-6863
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10268TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU51832Medicare UPIN
CASD102680Medicare ID - Type Unspecified