Provider Demographics
NPI:1124200894
Name:GREGORY W CHIN O D P A
Entity Type:Organization
Organization Name:GREGORY W CHIN O D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-551-6200
Mailing Address - Street 1:11455 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3311
Mailing Address - Country:US
Mailing Address - Phone:305-551-6200
Mailing Address - Fax:305-551-3696
Practice Address - Street 1:11455 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3311
Practice Address - Country:US
Practice Address - Phone:305-551-6200
Practice Address - Fax:305-551-3696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620687500Medicaid
FLAK398Medicare PIN