Provider Demographics
NPI:1770812794
Name:CHOW, BRIAN (OD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CHOW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1348
Mailing Address - Country:US
Mailing Address - Phone:503-362-5982
Mailing Address - Fax:503-588-8210
Practice Address - Street 1:3025 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1348
Practice Address - Country:US
Practice Address - Phone:503-362-5982
Practice Address - Fax:503-588-8210
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1746152W00000X
OR3313ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ162075Medicare PIN
AZZ162079Medicare PIN
AZZ162076Medicare PIN
AZZ162078Medicare PIN
AZZ163129Medicare PIN
AZZ162074Medicare PIN
AZ138677Medicare UPIN
AZZ163133Medicare PIN
AZZ163128Medicare PIN
AZZ163130Medicare PIN
AZZ163132Medicare PIN
AZZ163131Medicare PIN
AZZ162077Medicare PIN