Provider Demographics
NPI:1568562775
Name:CHEN, AMY YUANYI (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:YUANYI
Last Name:CHEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:Y
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:14020 SANFORD AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2562
Mailing Address - Country:US
Mailing Address - Phone:718-762-3838
Mailing Address - Fax:718-762-3591
Practice Address - Street 1:14020 SANFORD AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2562
Practice Address - Country:US
Practice Address - Phone:718-762-3838
Practice Address - Fax:718-762-3591
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006003152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTUV006003OtherHIP
NY2443534Medicaid
NYC347H1OtherEMPIRE BC/BS
NYP3091253OtherOXFORD
NYC347H1OtherEMPIRE BC/BS
NY06004Medicare ID - Type Unspecified