Provider Demographics
NPI:1689756629
Name:CHU, KATIE W (OD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:W
Last Name:CHU
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 1:3106 SAN GABRIEL BLVD
Mailing Address - Street 2:UNIT H
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2579
Mailing Address - Country:US
Mailing Address - Phone:626-288-6278
Mailing Address - Fax:626-571-1868
Practice Address - Street 1:3106 SAN GABRIEL BLVD
Practice Address - Street 2:UNIT H
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2579
Practice Address - Country:US
Practice Address - Phone:626-288-6278
Practice Address - Fax:626-571-1868
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10605 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP10605OtherOLD MEDICARE NUMBER
CASD0106050Medicaid
CAOP10605OtherOLD MEDICARE NUMBER
CASD0106050Medicaid