Provider Demographics
NPI:1588694137
Name:CHU, REX LC (OD)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:LC
Last Name:CHU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:16203 SIERRA PASS WAY
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6533
Mailing Address - Country:US
Mailing Address - Phone:626-353-4521
Mailing Address - Fax:
Practice Address - Street 1:13788 ROSWELL AVE
Practice Address - Street 2:#106
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1409
Practice Address - Country:US
Practice Address - Phone:909-627-5598
Practice Address - Fax:909-627-5298
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT 11120TPA152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV06977Medicare UPIN