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General NPI Number Information
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NPI Number | 1700251485
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Entity Type | Organization
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Legal Business Name | JEREMY CHIN, O.D.
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 530 SHOWERS DR
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-4740
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Country | US
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Telephone | 650-917-2318
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Fax |
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Provider Business Mailing Address
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Address Line | 530 SHOWERS DR
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-4740
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Country | US
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Telephone | 650-917-2318
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEREMY M CHIN
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Credential | O.D.
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Telephone | 510-299-6162
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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 | 15287
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License Number State | CA
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