Provider Demographics
NPI:1720003767
Name:CHU, CORINNE (OD)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:
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 1:6728 APPELL LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61016-9141
Mailing Address - Country:US
Mailing Address - Phone:815-332-2223
Mailing Address - Fax:815-332-4488
Practice Address - Street 1:7200 HARRISON AVE
Practice Address - Street 2:U265 CHERRYVALE MALL
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61112-1017
Practice Address - Country:US
Practice Address - Phone:815-332-2223
Practice Address - Fax:815-332-4488
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL9459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist