Provider Demographics
NPI:1104883370
Name:CHASENS, ELLEN CATINEAU (OD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:CATINEAU
Last Name:CHASENS
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 1:2600 GRANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5550
Mailing Address - Country:US
Mailing Address - Phone:305-807-8329
Mailing Address - Fax:
Practice Address - Street 1:2600 GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5550
Practice Address - Country:US
Practice Address - Phone:305-807-8329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC003092152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC0003092OtherLICENSE NUMBER