Provider Demographics
NPI:1447819990
Name:DO, CHI (OD)
Entity type:Individual
Prefix:
First Name:CHI
Middle Name:
Last Name:DO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2951
Mailing Address - Country:US
Mailing Address - Phone:214-516-8549
Mailing Address - Fax:
Practice Address - Street 1:1515 N TOWN EAST BLVD STE 173
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4142
Practice Address - Country:US
Practice Address - Phone:469-608-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9683152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist