Provider Demographics
NPI:1003919309
Name:CHESTER, KAREN ROSE (OD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ROSE
Last Name:CHESTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ROSE
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94623-2210
Mailing Address - Country:US
Mailing Address - Phone:510-535-4000
Mailing Address - Fax:510-535-4225
Practice Address - Street 1:3060 E 9TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2905
Practice Address - Country:US
Practice Address - Phone:510-535-5500
Practice Address - Fax:510-535-4349
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8698T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71087FOtherMEDI-CAL PROVIDER NUMBER
1124035159OtherSITE NPI
3762136OtherPIN
CA0647524Medicaid
CAZZZ2979ZOtherMEDICARE PROVIDER NUMBER
CA0647524Medicaid