Provider Demographics
NPI:1831356104
Name:DENNIS CHINN O D INC
Entity type:Organization
Organization Name:DENNIS CHINN O D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-224-8302
Mailing Address - Street 1:5151 N PALM AVE
Mailing Address - Street 2:530
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2211
Mailing Address - Country:US
Mailing Address - Phone:559-224-8302
Mailing Address - Fax:
Practice Address - Street 1:5151 N PALM AVE
Practice Address - Street 2:530
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2211
Practice Address - Country:US
Practice Address - Phone:559-224-8302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3477TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA410002873OtherRAILROAD MEDICARE
CA1558357145OtherNPI TYPE 1
CASD0034770Medicaid
CAT09391Medicare UPIN
CASD0034770Medicaid
CA0330110001Medicare NSC