Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT8698T | CA |
NPI | 1003919309 |
---|---|
Provider Name | Karen Rose Chester |
First Address | Oakland, CA 94623-2210 |
Second Address | Oakland, CA 94601-2905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 06/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0647524 | (05) | CA |
1124035159 | SITE NPI (01) | |
3762136 | PIN (01) | |
FHC71087F | MEDI-CAL PROVIDER NUMBER (01) | CA |
U31487 | (02) | |
ZZZ2979Z | MEDICARE PROVIDER NUMBER (01) | CA |