Provider Demographics
NPI:1265585426
Name:CHANGMIN DUAN OD PA
Entity type:Organization
Organization Name:CHANGMIN DUAN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANGMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-247-2847
Mailing Address - Street 1:190 STATE ROUTE 18
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1407
Mailing Address - Country:US
Mailing Address - Phone:732-247-2847
Mailing Address - Fax:732-246-2650
Practice Address - Street 1:223 STATE ROUTE 18 STE 107
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1913
Practice Address - Country:US
Practice Address - Phone:732-247-2847
Practice Address - Fax:732-246-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA05333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU52085Medicare UPIN
NJDU575956Medicare ID - Type Unspecified