Provider Demographics
NPI:1952714446
Name:CHEW, WESLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:
Last Name:CHEW
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 1:100 E CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3205
Mailing Address - Country:US
Mailing Address - Phone:888-884-3805
Mailing Address - Fax:
Practice Address - Street 1:1403 N TUSTIN AVE STE 399
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8691
Practice Address - Country:US
Practice Address - Phone:714-884-3961
Practice Address - Fax:714-884-3458
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14901TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952714446Medicaid
CACB245170Medicare UPIN