Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 6328TG | TX |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 6328TG | TX |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 6328TG | TX |
N | 152WP0200X | Pediatric Optomitrist | 6328TG | TX |
N | 152WS0006X | Sports Vision | 6328TG | TX |
N | 152WV0400X | Optomitrist - Vision Therapist | 6328TG | TX |
N | 152WX0102X | Occupational Vision | 6328TG | TX |
NPI | 1255313599 |
---|---|
Provider Name | Dr. Robert Chu |
First Address | Fort Worth, TX 76132-1401 |
Second Address | Fort Worth, TX 76132-1401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 10/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U95525 | (02) | TX |