Provider Demographics
NPI:1093363384
Name:EHIE, CHINAZO CRYSTAL (OD)
Entity type:Individual
Prefix:DR
First Name:CHINAZO
Middle Name:CRYSTAL
Last Name:EHIE
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 1:3200 W PLEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1073
Mailing Address - Country:US
Mailing Address - Phone:469-747-3027
Mailing Address - Fax:303-800-2078
Practice Address - Street 1:3200 W PLEASANT RUN RD STE 200
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1084
Practice Address - Country:US
Practice Address - Phone:469-747-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9817T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist