Provider Demographics
NPI:1104469287
Name:CHIU, JIN (OD)
Entity type:Individual
Prefix:
First Name:JIN
Middle Name:
Last Name:CHIU
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 1:225 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-8693
Mailing Address - Country:US
Mailing Address - Phone:718-384-4700
Mailing Address - Fax:718-387-3139
Practice Address - Street 1:225 S 4TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8693
Practice Address - Country:US
Practice Address - Phone:718-384-4700
Practice Address - Fax:718-387-3139
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009051152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty