Provider Demographics
NPI:1710326657
Name:CHU, JENNIFER WAI-LING (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:WAI-LING
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 1:20 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60416-1087
Mailing Address - Country:US
Mailing Address - Phone:815-634-4825
Mailing Address - Fax:
Practice Address - Street 1:20 E NORTH ST
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-1087
Practice Address - Country:US
Practice Address - Phone:815-634-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010684152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist