Provider Demographics
NPI:1871554113
Name:CHIN, LAWRENCE Y (OD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:Y
Last Name:CHIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:109 S CALIFORNIA AVE
Mailing Address - Street 2:# 101D
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1926
Mailing Address - Country:US
Mailing Address - Phone:650-322-6656
Mailing Address - Fax:650-323-2020
Practice Address - Street 1:163 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1619
Practice Address - Country:US
Practice Address - Phone:650-322-6656
Practice Address - Fax:650-323-2020
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5643T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0056430Medicaid
CA0794230001OtherDEMERC
CAT10066Medicare UPIN
CASD0056430Medicaid