MEDICARE: LAURIE CHALKIN

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	152WV0400X	Vision Therapy Optometrist	7597	CA
2	152WL0500X	Low Vision Rehabilitation Optometrist	10195	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679641203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURIE CHALKIN

Provider Business Mailing Address
First Line	:	3717 CASTRO VALLEY BLVD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4405
Country	:	US
Telephone Number	:	510-538-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	3717 CASTRO VALLEY BLVD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4405
Country	:	US
Telephone Number	:	510-538-3937
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST OWNER
Name	:	MS. LAURIE RUTH CHAIKIN
Credential	:	O.D.
Telephone Number	:	510-538-3937

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/22/2008

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Directions to “LAURIE CHALKIN ” Practice Location

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