MEDICARE: CHRISTINE J.J. CHAO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	10612T	CA

General Provider Information

NPI Number	:	1437125523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE J.J. CHAO O.D.

Provider Business Mailing Address
First Line	:	1970 LAKE BLVD
Second Line	:	STE 7
City	:	DAVIS
State	:	CA
Zip	:	95616-5663
Country	:	US
Telephone Number	:	530-756-9393
Fax Number	:	530-756-9398

Provider Business Practice Location Address
First Line	:	1970 LAKE BLVD
Second Line	:	STE 7
City	:	DAVIS
State	:	CA
Zip	:	95616-5663
Country	:	US
Telephone Number	:	530-756-9393
Fax Number	:	530-756-9398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	11/08/2016

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