MEDICARE: BRENT P CHINN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9874T	CA

General Provider Information

NPI Number	:	1023088796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT P CHINN O.D.

Provider Business Mailing Address
First Line	:	1039 EL MONTE AVE
Second Line	:	STE K
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2370
Country	:	US
Telephone Number	:	650-967-0140
Fax Number	:	650-967-3925

Provider Business Practice Location Address
First Line	:	1039 EL MONTE AVE
Second Line	:	STE K
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2370
Country	:	US
Telephone Number	:	650-967-0140
Fax Number	:	650-967-3925

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	11/23/2011

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