=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821493453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BONNIE CHOW, O.D. INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2014
-----------------------------------------------------
Last Update Date | 10/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8230 TALBERT AVE
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92646-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-842-2795
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8230 TALBERT AVE
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92646-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-842-2795
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BONNIE CHOW
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 714-842-2795
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 12284TG
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------