Provider Demographics
NPI:1184294183
Name:VIBOL, CHHAPEAN (OD)
Entity type:Individual
Prefix:
First Name:CHHAPEAN
Middle Name:
Last Name:VIBOL
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 1:2 CONSHOHOCKEN STATE RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3386
Mailing Address - Country:US
Mailing Address - Phone:610-668-1373
Mailing Address - Fax:
Practice Address - Street 1:2 CONSHOHOCKEN STATE RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3386
Practice Address - Country:US
Practice Address - Phone:610-668-1373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist