Provider Demographics
NPI:1366061038
Name:CHOU, CAROL ANN
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:CHOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-9175
Mailing Address - Country:US
Mailing Address - Phone:217-836-4114
Mailing Address - Fax:
Practice Address - Street 1:4317 FACTORIA BLVD SE STE A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1937
Practice Address - Country:US
Practice Address - Phone:425-641-2020
Practice Address - Fax:425-641-7899
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61198834152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2188229Medicaid