Provider Demographics
NPI:1821373127
Name:JULIE EDITH CHEN, O.D. A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:JULIE EDITH CHEN, O.D. A PROFESSIONAL CORP.
Other - Org Name:CONCOURSE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-545-8431
Mailing Address - Street 1:2272 MICHELSON DR STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1324
Mailing Address - Country:US
Mailing Address - Phone:949-851-2015
Mailing Address - Fax:888-851-9029
Practice Address - Street 1:2272 MICHELSON DR STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1324
Practice Address - Country:US
Practice Address - Phone:949-851-2015
Practice Address - Fax:888-851-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT1113T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FW403Medicare PIN