Healthcare Provider Details

I. General information

NPI: 1124773536
Provider Name (Legal Business Name): CHOU OPTOMETRY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 05/15/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28356 S WESTERN AVE
RANCHO PALOS VERDES CA
90275-1434
US

IV. Provider business mailing address

28356 S WESTERN AVE
RANCHO PALOS VERDES CA
90275-1434
US

V. Phone/Fax

Practice location:
  • Phone: 310-831-0841
  • Fax: 310-831-0842
Mailing address:
  • Phone: 310-831-0841
  • Fax: 310-831-0842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY M CHOU
Title or Position: PRESIDENT
Credential: OD
Phone: 909-569-9703