Provider Demographics
NPI:1386078020
Name:CHA, DANIEL (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:CHA
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 1:4158 DECORO ST
Mailing Address - Street 2:12
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1419
Mailing Address - Country:US
Mailing Address - Phone:619-916-1455
Mailing Address - Fax:
Practice Address - Street 1:4502 BONITA RD
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1427
Practice Address - Country:US
Practice Address - Phone:619-479-7334
Practice Address - Fax:619-475-3456
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist