Provider Demographics
NPI:1588736367
Name:CHAO, JACKIE HUEI-HUAN (OD)
Entity type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:HUEI-HUAN
Last Name:CHAO
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 1:75 PETERBOROUGH ST APT 403
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4313
Mailing Address - Country:US
Mailing Address - Phone:206-920-9929
Mailing Address - Fax:
Practice Address - Street 1:1125 TREMONT ST
Practice Address - Street 2:
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2178
Practice Address - Country:US
Practice Address - Phone:617-989-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2025351Medicaid
WA2025351Medicaid
WAU86636Medicare UPIN