Provider Demographics
NPI:1265279004
Name:CHU, BRIAN PETER (OD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PETER
Last Name:CHU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 69TH ST APT 1503W
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5984
Mailing Address - Country:US
Mailing Address - Phone:678-557-5380
Mailing Address - Fax:
Practice Address - Street 1:839 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4662
Practice Address - Country:US
Practice Address - Phone:678-557-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist