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General NPI Number Information
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NPI Number | 1043371255
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Entity Type | Individual
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Provider Name | LAURA M. CHONKO O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 24801 BROOKPARK RD
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3487
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Country | US
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Telephone | 440-979-9546
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Fax |
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Provider Business Mailing Address
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Address Line | 33532 AUGUSTA WAY
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City | AVON
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State | OH
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Zip | 44011-2782
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Country | US
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Telephone | 440-937-3711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5017
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License Number State | OH
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