Provider Demographics
NPI:1982645420
Name:CHIN, FREDA (OD)
Entity Type:Individual
Prefix:DR
First Name:FREDA
Middle Name:
Last Name:CHIN
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 1:46 S. DEL PUERTO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-2542
Mailing Address - Country:US
Mailing Address - Phone:209-892-2161
Mailing Address - Fax:209-892-5512
Practice Address - Street 1:46 S. DEL PUERTO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-2518
Practice Address - Country:US
Practice Address - Phone:209-892-2161
Practice Address - Fax:209-892-5512
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT10755152W00000X
CA10755T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0107551Medicaid
CAU67703Medicare UPIN
CASD0107551Medicaid