Provider Demographics
NPI:1124257761
Name:CHEN, ARTHUR (OD)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:CHEN
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 1:20836 CROSS ISLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1187
Mailing Address - Country:US
Mailing Address - Phone:718-224-1833
Mailing Address - Fax:718-224-1877
Practice Address - Street 1:20836 CROSS ISLAND PKWY
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1187
Practice Address - Country:US
Practice Address - Phone:718-224-1833
Practice Address - Fax:718-224-1877
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03127020Medicaid