Provider Demographics
NPI:1083863161
Name:CHEN EYE CENTER JOHNS CREEK
Entity Type:Organization
Organization Name:CHEN EYE CENTER JOHNS CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:Y W
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-448-5587
Mailing Address - Street 1:6335 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1549
Mailing Address - Country:US
Mailing Address - Phone:770-448-4487
Mailing Address - Fax:678-475-0504
Practice Address - Street 1:6325 HOSPITAL PKWY
Practice Address - Street 2:SUITE 115
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-5775
Practice Address - Country:US
Practice Address - Phone:770-948-3070
Practice Address - Fax:678-475-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002370152W00000X
GA046583207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty