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General NPI Number Information
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NPI Number | 1639211360
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Entity Type | Organization
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Legal Business Name | CHINO OPTOMETRY CENTER
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 11640 CENTRAL AVE
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City | CHINO
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State | CA
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Zip | 91710-1923
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Country | US
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Telephone | 909-627-7363
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Fax | 909-627-9854
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Provider Business Mailing Address
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Address Line | 11640 CENTRAL AVE
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City | CHINO
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State | CA
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Zip | 91710-1923
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Country | US
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Telephone | 909-627-7363
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Fax | 909-627-9854
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN T JU
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Credential | O.D.
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Telephone | 909-627-7363
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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 | OPT6062TPA
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License Number State | CA
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