Provider Demographics
NPI:1386857100
Name:CHEN, JENNIFER LYN (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:CHEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10534 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-2626
Mailing Address - Country:US
Mailing Address - Phone:301-304-0373
Mailing Address - Fax:301-527-1040
Practice Address - Street 1:10534 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-2626
Practice Address - Country:US
Practice Address - Phone:301-304-0373
Practice Address - Fax:301-527-1040
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist