Provider Demographics
NPI:1942881180
Name:MINA CHEN OD CORP
Entity Type:Organization
Organization Name:MINA CHEN OD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-709-7294
Mailing Address - Street 1:561 CARLSON AVE APT 332
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2801
Mailing Address - Country:US
Mailing Address - Phone:510-709-7294
Mailing Address - Fax:
Practice Address - Street 1:157 PETALUMA BLVD N
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2904
Practice Address - Country:US
Practice Address - Phone:707-285-7475
Practice Address - Fax:707-285-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty