Provider Demographics
NPI:1538246715
Name:FREDA CHIN, O.D.,INC
Entity type:Organization
Organization Name:FREDA CHIN, O.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:209-892-2161
Mailing Address - Street 1:46 S. DEL PUERTO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-2518
Mailing Address - Country:US
Mailing Address - Phone:209-892-2161
Mailing Address - Fax:
Practice Address - Street 1:46 S. DEL PUERTO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-2518
Practice Address - Country:US
Practice Address - Phone:209-892-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10755T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0107551Medicaid
CASD0107551Medicaid
CAU67703Medicare UPIN
CA5445570001Medicare NSC