Provider Demographics
NPI:1073753976
Name:WILLIE Y W CHEN MD PC INC
Entity Type:Organization
Organization Name:WILLIE Y W CHEN MD PC INC
Other - Org Name:CHEN EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:YW
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-448-5587
Mailing Address - Street 1:5825 BUFORD HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2545
Mailing Address - Country:US
Mailing Address - Phone:770-448-5587
Mailing Address - Fax:770-448-4086
Practice Address - Street 1:5825 BUFORD HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2545
Practice Address - Country:US
Practice Address - Phone:770-448-5587
Practice Address - Fax:770-448-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002370152W00000X
GAOPT001796152W00000X
GA046583207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOPT001796OtherSTATE LICENSE
GAOPT002370OtherSTATE LICENSE
GA046583OtherSTATE LICENSE