Provider Demographics
NPI:1801065560
Name:PETER CHU OD
Entity type:Organization
Organization Name:PETER CHU OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-355-4414
Mailing Address - Street 1:144 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EUDORA
Mailing Address - State:AR
Mailing Address - Zip Code:71640-3059
Mailing Address - Country:US
Mailing Address - Phone:870-355-4414
Mailing Address - Fax:
Practice Address - Street 1:144 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EUDORA
Practice Address - State:AR
Practice Address - Zip Code:71640-3059
Practice Address - Country:US
Practice Address - Phone:870-355-4414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2354332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0276100001Medicare NSC