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General NPI Number Information
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NPI Number | 1275619827
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Entity Type | Individual
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Provider Name | CHRISTINE CHIZUKO TERADA O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5512 E BRITTON DR STE 200
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City | LONG BEACH
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State | CA
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Zip | 90815-3149
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Country | US
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Telephone | 562-421-2020
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Fax | 562-594-4696
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Provider Business Mailing Address
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Address Line | 17281 MILL CIR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-6210
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Country | US
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Telephone | 714-847-3659
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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 | OPT9749
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License Number State | CA
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