Provider Demographics
NPI:1902866056
Name:CHIN, MARY (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:CHIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2601 OCEAN PKWY
Mailing Address - Street 2:OPHTHALMOLOGY DEPARTMENT ROOM 5N14
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7745
Mailing Address - Country:US
Mailing Address - Phone:718-616-3703
Mailing Address - Fax:718-616-3004
Practice Address - Street 1:2601 OCEAN PKWY
Practice Address - Street 2:OPHTHALMOLOGY DEPARTMENT ROOM 5N14
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7745
Practice Address - Country:US
Practice Address - Phone:718-616-3703
Practice Address - Fax:718-616-3004
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC428D1Medicare ID - Type Unspecified
NYV07642Medicare UPIN