Healthcare Provider Details

I. General information

NPI: 1700812997
Provider Name (Legal Business Name): LAWRENCE C CHAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALTON PKWY SUITE 102
IRVINE CA
92606-5024
US

IV. Provider business mailing address

2500 ALTON PKWY STE 102
IRVINE CA
92606-5032
US

V. Phone/Fax

Practice location:
  • Phone: 949-679-2426
  • Fax: 949-679-2616
Mailing address:
  • Phone: 949-679-2426
  • Fax: 949-679-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG84067
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberG84067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: