NPI Number: 1538497540
Health Care Provider/Practitioner: BRENT P. CHINN, OD AND DAVID M. REDMAN, OD, OPTOMETRIC GROUP, INC
Information about “1538497540” NPI (BRENT P. CHINN, OD AND DAVID M. REDMAN, OD, OPTOMETRIC GROUP, INC)
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<?xml version="1.0" encoding="UTF-8"?>
<Npi>
<NPI>
1538497540
</NPI>
<EntityType>
Organization
</EntityType>
<ReplacementNPI/>
<EIN/>
<IsSoleProprietor/>
<IsOrgSubpart>
N
</IsOrgSubpart>
<ParentOrgLBN/>
<ParentOrgTIN/>
<OrgName>
BRENT P. CHINN, OD AND DAVID M. REDMAN, OD, OPTOMETRIC GROUP, INC
</OrgName>
<LastName/>
<FirstName/>
<MiddleName/>
<NamePrefix/>
<NameSuffix/>
<Credential/>
<OtherOrgName/>
<OtherOrgNameTypeCode>
6
</OtherOrgNameTypeCode>
<OtherLastName/>
<OtherFirstName/>
<OtherMiddleName/>
<OtherNamePrefix/>
<OtherNameSuffix/>
<OtherCredential/>
<OtherLastNameTypeCode/>
<FirstLineMailingAddress>
1039 EL MONTE AVE STE K
</FirstLineMailingAddress>
<SecondLineMailingAddress/>
<MailingAddressCityName>
MOUNTAIN VIEW
</MailingAddressCityName>
<MailingAddressStateName>
CA
</MailingAddressStateName>
<MailingAddressPostalCode>
94040-2371
</MailingAddressPostalCode>
<MailingAddressCountryCode>
US
</MailingAddressCountryCode>
<MailingAddressTelephoneNumber>
650-967-0140
</MailingAddressTelephoneNumber>
<MailingAddressFaxNumber>
650-967-3925
</MailingAddressFaxNumber>
<FirstLinePracticeLocationAddress>
1039 EL MONTE AVE STE K
</FirstLinePracticeLocationAddress>
<SecondLinePracticeLocationAddress/>
<PracticeLocationAddressCityName>
MOUNTAIN VIEW
</PracticeLocationAddressCityName>
<PracticeLocationAddressStateName>
CA
</PracticeLocationAddressStateName>
<PracticeLocationAddressPostalCode>
94040-2371
</PracticeLocationAddressPostalCode>
<PracticeLocationAddressCountryCode>
US
</PracticeLocationAddressCountryCode>
<PracticeLocationAddressTelephoneNumber>
650-967-0140
</PracticeLocationAddressTelephoneNumber>
<PracticeLocationAddressFaxNumber>
650-967-3925
</PracticeLocationAddressFaxNumber>
<EnumerationDate>
12/02/2009
</EnumerationDate>
<LastUpdateDate>
01/03/2012
</LastUpdateDate>
<NPIDeactivationReasonCode/>
<NPIDeactivationReason/>
<NPIDeactivationDate/>
<NPIReactivationDate/>
<GenderCode/>
<Gender/>
<AuthorizedOfficialLastName>
CHINN
</AuthorizedOfficialLastName>
<AuthorizedOfficialFirstName>
BRENT
</AuthorizedOfficialFirstName>
<AuthorizedOfficialMiddleName>
PHILLIP
</AuthorizedOfficialMiddleName>
<AuthorizedOfficialTitle>
OWNER
</AuthorizedOfficialTitle>
<AuthorizedOfficialNamePrefix/>
<AuthorizedOfficialNameSuffix/>
<AuthorizedOfficialCredential>
O.D.
</AuthorizedOfficialCredential>
<AuthorizedOfficialTelephoneNumber>
650-967-0140
</AuthorizedOfficialTelephoneNumber>
<Taxonomies>
<Taxonomy>
<TaxonomyCode>
152W00000X
</TaxonomyCode>
<TaxonomyName>
Optometrist
</TaxonomyName>
<LicenseNumber>
9874T
</LicenseNumber>
<LicenseNumberStateCode>
CA
</LicenseNumberStateCode>
<PrimaryTaxonomySwitch>
Y
</PrimaryTaxonomySwitch>
</Taxonomy>
</Taxonomies>
<HealthcareProviderTaxonomyGroups>
<HealthcareProviderTaxonomyGroup>
<HealthcareProviderTaxonomyGroupName>
193400000X SINGLE SPECIALTY GROUP
</HealthcareProviderTaxonomyGroupName>
<HealthcareProviderTaxonomyGroupDescription>
Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization.
</HealthcareProviderTaxonomyGroupDescription>
</HealthcareProviderTaxonomyGroup>
</HealthcareProviderTaxonomyGroups>
</Npi>
<?xml version="1.0" encoding="UTF-8"?>
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