Provider Demographics
NPI:1285935205
Name:CHU, ELAINE VIVIAN (OD)
Entity type:Individual
Prefix:MISS
First Name:ELAINE
Middle Name:VIVIAN
Last Name:CHU
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 1:3 PLUM TREE CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5241
Mailing Address - Country:US
Mailing Address - Phone:908-616-4146
Mailing Address - Fax:
Practice Address - Street 1:169 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2927
Practice Address - Country:US
Practice Address - Phone:212-460-9240
Practice Address - Fax:212-253-0764
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00628600152W00000X
NYTUV007650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1285935205Medicare PIN