Provider Demographics
NPI:1871547786
Name:CHU, CHARLEY M (O D)
Entity type:Individual
Prefix:DR
First Name:CHARLEY
Middle Name:M
Last Name:CHU
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325C N SEBASTIAN
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-2417
Mailing Address - Country:US
Mailing Address - Phone:870-572-7886
Mailing Address - Fax:
Practice Address - Street 1:325C N SEBASTIAN
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-2417
Practice Address - Country:US
Practice Address - Phone:870-572-7886
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20237Medicare UPIN
AR48836Medicare ID - Type Unspecified