Provider Demographics
NPI:1770906430
Name:OTEY, CHAKA
Entity type:Individual
Prefix:
First Name:CHAKA
Middle Name:
Last Name:OTEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8032 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:VA
Mailing Address - Zip Code:23141-2406
Mailing Address - Country:US
Mailing Address - Phone:804-932-3992
Mailing Address - Fax:
Practice Address - Street 1:8032 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141
Practice Address - Country:US
Practice Address - Phone:804-932-3992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA127006018017Medicaid