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General NPI Number Information
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NPI Number | 1447819990
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Entity Type | Individual
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Provider Name | CHI DO OD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2019
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Last Update Date | 06/09/2019
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Provider Practice Location Address
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Address Line | 1515 N TOWN EAST BLVD STE 173
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City | MESQUITE
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State | TX
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Zip | 75150-4142
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Country | US
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Telephone | 469-608-2654
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Fax |
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Provider Business Mailing Address
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Address Line | 4740 MEADOWVIEW DR
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City | MESQUITE
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State | TX
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Zip | 75150-2951
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Country | US
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Telephone | 214-516-8549
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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 | 9683
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License Number State | TX
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