Provider Demographics
NPI:1992839245
Name:CHEN, VINCENT WAI (OD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:WAI
Last Name:CHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 NOGALES ST
Mailing Address - Street 2:#109
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1360
Mailing Address - Country:US
Mailing Address - Phone:626-965-8698
Mailing Address - Fax:626-965-8697
Practice Address - Street 1:1015 NOGALES ST
Practice Address - Street 2:#109
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-1360
Practice Address - Country:US
Practice Address - Phone:626-965-8698
Practice Address - Fax:626-965-8697
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125555T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB236832OtherMEDICARE PTAN
CASD012550Medicaid
CAV05020Medicare UPIN