Provider Demographics
NPI:1922112507
Name:CHEN, STEPHANIE YACHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE YACHEN
Middle Name:
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 1:7004 CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4807
Mailing Address - Country:US
Mailing Address - Phone:469-688-0399
Mailing Address - Fax:972-392-0884
Practice Address - Street 1:4122 L B J FWY STE 120
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-5703
Practice Address - Country:US
Practice Address - Phone:972-392-0884
Practice Address - Fax:972-392-0884
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6065T152WC0802X
TX6065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3795528Medicaid
TX8F4937OtherMEDICARE PTAN