MEDICARE: KENNETH F CHU OD

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	9894T	CA

General Provider Information

NPI Number	:	1811033285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH F CHU OD

Provider Business Mailing Address
First Line	:	915 S CATALINA AVE STE C
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-4795
Country	:	US
Telephone Number	:	310-372-5213
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 S CATALINA AVE STE C
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-4795
Country	:	US
Telephone Number	:	310-372-5213
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	06/11/2016

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