Provider Demographics
NPI:1154939742
Name:CHU, JASON (OD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
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 1:401 S MOUNT JULIET RD STE 367
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8544
Mailing Address - Country:US
Mailing Address - Phone:615-758-0874
Mailing Address - Fax:615-758-5095
Practice Address - Street 1:401 S MOUNT JULIET RD STE 367
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8544
Practice Address - Country:US
Practice Address - Phone:615-758-0874
Practice Address - Fax:615-758-5095
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist