Provider Demographics
NPI:1891865267
Name:KATIE W. CHU, O.D., INC.
Entity Type:Organization
Organization Name:KATIE W. CHU, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:WANKAY
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-298-0790
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR 1116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0106050Medicaid
CASD0106050Medicaid