Provider Demographics
NPI:1740408442
Name:CHU, LILI C (OD)
Entity Type:Individual
Prefix:
First Name:LILI
Middle Name:C
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 1:6106 SANFORD RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-5728
Mailing Address - Country:US
Mailing Address - Phone:713-436-0106
Mailing Address - Fax:
Practice Address - Street 1:10505 BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8076
Practice Address - Country:US
Practice Address - Phone:713-436-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05351TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXVTX004030OtherAVESIS
TX00797PMedicare ID - Type Unspecified
TXU65089Medicare UPIN