Provider Demographics
NPI:1790861524
Name:CHA, JENNY Y (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:Y
Last Name:CHA
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 1:221 ADDISON RD.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-5608
Mailing Address - Country:US
Mailing Address - Phone:860-838-3838
Mailing Address - Fax:860-838-3840
Practice Address - Street 1:221 ADDISON RD.
Practice Address - Street 2:SUITE 105
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-5608
Practice Address - Country:US
Practice Address - Phone:860-838-3838
Practice Address - Fax:860-838-3840
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2545530OtherAETNA ID #
CTCT2469OtherEYEMED ID#
CT785099OtherCONNECTICARE ID #
CT2204101OtherUNITED HEALTHCARE ID#
CT090002469CT13OtherBC/BS
CT8058685Medicaid
CTOV8875OtherHEALTHNET ID #