Provider Demographics
NPI:1265423131
Name:CHEW, THERESA TAI NGOR (OD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:TAI NGOR
Last Name:CHEW
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 1:781 VALLEJO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133
Mailing Address - Country:US
Mailing Address - Phone:415-677-9930
Mailing Address - Fax:415-677-9599
Practice Address - Street 1:781 VALLEJO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133
Practice Address - Country:US
Practice Address - Phone:415-677-9930
Practice Address - Fax:415-677-9599
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09873T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0098730Medicaid
CAGSD004530Medicaid
CA1043474133Medicaid
CA1043474133Medicaid
CAU39000Medicare UPIN
CASD0098730Medicaid
CA6176620001Medicare NSC
CABM366Medicare PIN