MEDICARE: DR. GLORIA 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	TUV007892-1	NY
2	152W00000X	Optometrist	14690	CA

General Provider Information

NPI Number	:	1760731434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIA CHOW O.D.

Provider Business Mailing Address
First Line	:	1575 ALUM ROCK AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-2426
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 ALUM ROCK AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-2426
Country	:	US
Telephone Number	:	408-259-2020
Fax Number	:

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

Provider Enumeration Date	:	09/10/2012
Last Update Date	:	04/07/2022

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