Provider Demographics
NPI:1902974009
Name:CHAHINE, TONY (OD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:CHAHINE
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 1:1419 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2108
Mailing Address - Country:US
Mailing Address - Phone:818-790-0422
Mailing Address - Fax:818-790-0484
Practice Address - Street 1:1419 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2108
Practice Address - Country:US
Practice Address - Phone:818-790-0422
Practice Address - Fax:818-790-0484
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10577T152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADM868ZMedicare PIN
CAU58226Medicare UPIN
CA5003100001Medicare NSC