Provider Demographics
NPI:1063466571
Name:CHIN, SCOTT NELSON (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:NELSON
Last Name:CHIN
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 1:741 W 47TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-4410
Mailing Address - Country:US
Mailing Address - Phone:312-804-2446
Mailing Address - Fax:
Practice Address - Street 1:741 W 47TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-4410
Practice Address - Country:US
Practice Address - Phone:312-804-2446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU74233Medicare UPIN