Provider Demographics
NPI:1023088796
Name:CHINN, BRENT P (OD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:P
Last Name:CHINN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1039 EL MONTE AVE
Mailing Address - Street 2:STE K
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2370
Mailing Address - Country:US
Mailing Address - Phone:650-967-0140
Mailing Address - Fax:650-967-3925
Practice Address - Street 1:1039 EL MONTE AVE
Practice Address - Street 2:STE K
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2370
Practice Address - Country:US
Practice Address - Phone:650-967-0140
Practice Address - Fax:650-967-3925
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA9874T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADI164ZMedicare PIN