Provider Demographics
NPI:1245332089
Name:CHEN, OLIVER T (OD)
Entity type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:T
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 1:1905 CALLE BARCELONA
Mailing Address - Street 2:STE. 208
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8450
Mailing Address - Country:US
Mailing Address - Phone:760-930-9696
Mailing Address - Fax:760-930-0737
Practice Address - Street 1:1905 CALLE BARCELONA
Practice Address - Street 2:STE. 208
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8450
Practice Address - Country:US
Practice Address - Phone:760-930-9696
Practice Address - Fax:760-930-0737
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12395T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV07514Medicare UPIN
CAOP12395Medicare PIN