Healthcare Provider Details

I. General information

NPI: 1902974017
Provider Name (Legal Business Name): TONY CHAHINE, O.D., INC., APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 FOOTHILL BLVD
LA CANADA CA
91011-2108
US

IV. Provider business mailing address

1419 FOOTHILL BLVD
LA CANADA CA
91011-2108
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-0422
  • Fax: 818-790-0484
Mailing address:
  • Phone: 818-790-0422
  • Fax: 818-790-0484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10577T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number10577T
License Number StateCA

VIII. Authorized Official

Name: DR. TONY CHAHINE
Title or Position: PRESIDENT
Credential: O.D.
Phone: 818-790-0422