Provider Demographics
NPI:1528050093
Name:CHU, AMY TIEN-TSUEN (OD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:TIEN-TSUEN
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 1:21851 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-3304
Mailing Address - Country:US
Mailing Address - Phone:310-830-0632
Mailing Address - Fax:310-830-9827
Practice Address - Street 1:21851 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3304
Practice Address - Country:US
Practice Address - Phone:310-830-0632
Practice Address - Fax:310-830-9827
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10304TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0103040Medicaid
CAU61844Medicare UPIN
CAOP10304Medicare PIN