MEDICARE: DR. KEITH DARREN CHOW 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	10268TPL	CA

General Provider Information

NPI Number	:	1568432110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH DARREN CHOW O.D.

Provider Business Mailing Address
First Line	:	1673 BRANHAM LN
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-5211
Country	:	US
Telephone Number	:	408-269-6861
Fax Number	:	408-269-6863

Provider Business Practice Location Address
First Line	:	1673 BRANHAM LN
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-5211
Country	:	US
Telephone Number	:	408-269-6861
Fax Number	:	408-269-6863

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	10/12/2011

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