MEDICARE: STEPHEN CHINN OD A PROFESSIONAL CORPERATION DBA AS STEPHEN CHINN OD

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	305R00000X	Preferred Provider Organization	5373TPL	CA

General Provider Information

NPI Number	:	1881901932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN CHINN OD A PROFESSIONAL CORPERATION DBA AS STEPHEN CHINN OD

Provider Business Mailing Address
First Line	:	2811 UNIVERSITY AVE
Second Line	:	SUITE C
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2904
Country	:	US
Telephone Number	:	619-280-0664
Fax Number	:	619-294-8100

Provider Business Practice Location Address
First Line	:	2811 UNIVERSITY AVE
Second Line	:	SUITE C
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2904
Country	:	US
Telephone Number	:	619-280-0664
Fax Number	:	619-294-8100

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. STEPHEN CHINN
Credential	:	O.D.
Telephone Number	:	619-280-0664

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	09/10/2010

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