Provider Demographics
NPI:1700812997
Name:CHAO, LAWRENCE C (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:C
Last Name:CHAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ALTON PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5032
Mailing Address - Country:US
Mailing Address - Phone:949-679-2426
Mailing Address - Fax:949-679-2616
Practice Address - Street 1:2500 ALTON PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5024
Practice Address - Country:US
Practice Address - Phone:949-679-2426
Practice Address - Fax:949-679-2616
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84067207W00000X, 207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G840670OtherMEDI-CAL PROVIDER #
CAG57128Medicare UPIN
CAWG84067CMedicare PIN
CAWG84067AMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
CAWG84067BMedicare ID - Type UnspecifiedMEDICARE PROVIDER #